Previous differences in guideline recommendation strength for CYP2C19 intermediate metabolizers may have limited genotype (PGx)-optimal post-percutaneous coronary intervention antiplatelet prescribing. In this single-center retrospective observational cohort study of CYP2C19 intermediate metabolizers, patients prescribed PGx-optimal therapy were younger and less likely on anticoagulation (2 vs 12%;  = 0.006). More patients prescribed PGx-optimal therapy possessed commercial insurance (36 vs 7%;  < 0.001), which was a predictor for PGx-optimal selection (OR: 6.464; 95% CI: 2.386-17.516;  < 0.001). Anticoagulation use was significantly associated with clopidogrel use (OR: 0.138; 95% CI: 0.0260.730;  = 0.020). No statistical difference in composite major adverse cardiovascular events (5 vs 14%;  = 0.173) or bleeding (8 vs 6%; Not significant) was observed between PGx-optimal and PGx-suboptimal therapy.