The following are key points to remember from the updated Expert Consensus Statement on platelet function and genetic testing for guiding P2Y₁₂ receptor inhibitor treatment in percutaneous coronary intervention (PCI):

1. Dual antiplatelet therapy (DAPT) with aspirin and a P2Y₁₂ receptor inhibitor is the standard treatment for patients undergoing PCI.
2. The availability of different P2Y₁₂ receptor inhibitors (clopidogrel, prasugrel, ticagrelor) with varying levels of potency has enabled physicians to contemplate individualized treatment regimens, which may include escalation or deescalation of P2Y₁₂-inhibiting therapy.
3. Indeed, individualized and alternative DAPT strategies may be chosen according to the clinical setting (stable coronary artery disease vs. acute coronary syndrome), the stage of the disease (early vs. long-term treatment), and patient risk for ischemic and bleeding complications.
4. A tailored DAPT approach may potentially be guided by platelet function testing (PFT) or genetic testing.
5. Although the routine use of PFT or genetic testing in PCI-treated patients is not recommended, recent data have led to an update in guideline recommendations that allows considering selective use of PFT for DAPT de-escalation.
6. Clinicians should note that although results of proof-of-concept studies may make a guided approach on drug selection attractive, the robustness of the evidence, particularly when considering adequately powered randomized trials, still does not allow recommending the routine use of PFT or genetic testing in clinical practice.
7. Of note, when used, point-of-care PFT and genotyping assays are preferred over laboratory-based assays and selection of assay should depend on the local site experience and availability.
8. In selected cases, escalation strategies may be desired when thrombotic risk outweighs bleeding risk, and similarly, de-escalation strategies may be desired when bleeding risk outweighs thrombotic risk.
9. In this context, PFT and genetic testing may be considered as optional tools for guidance of treatment when either DAPT escalation or de-escalation is required. Furthermore, the results of these tests should never be used alone but must be integrated with numerous other clinical, angiographic, procedural, and socioeconomic variables, which together should guide optimal DAPT decisions.
10. The results of ongoing strategy trials that focus on various areas of clinical use (DAPT escalation, DAPT de-escalation, timing of surgery) will further refine the field of personalizing P2Y₁₂ receptor inhibitor treatment in patients undergoing PCI.

Clinical Topics: Acute Coronary Syndromes, Invasive Cardiovascular Angiography and Intervention, Prevention, Atherosclerotic Disease (CAD/PAD), Interventions and ACS, Interventions and Coronary Artery Disease

Keywords: Acute Coronary Syndrome, Adenosine, Aspirin, Blood Platelets, Coronary Artery Disease, Genetic Testing, Genotype, Genotyping Techniques, Myocardial Ischemia, Percutaneous Coronary Intervention, Platelet Function Tests, Primary Prevention, Thrombosis

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