Is there a risk of CYP2C19 gene testing only being adopted by wealthier health systems, thereby creating a disparity gap in treatment?  

I do not believe this test is widely available for use in clinical practice. There is a serum platelet assay that checks for P2Y12 receptor inhibition that is widely available and could be an alternative to CYP2C19 testing. 

It is likely that CYP2c19 metabolizer status will be available in better-resourced health care systems unless the testing becomes widely available with a quick turnaround and is inexpensive.

It is likely that both genetic testing and ticagrelor treatment will only be adopted in wealthier countries and with wealthier individuals in those countries. This is likely to exacerbate current inequity in stroke care and outcomes. That being said, there is substantial room for improvement in trea...