Relation of proton pump inhibitor use after percutaneous coronary intervention with drug-eluting stents to outcomes.
Recent evidence has shown that clopidogrel and proton pump inhibitors (PPIs) are metabolized by the same pathway and that patients taking both drugs have greater levels of platelet reactivity and more adverse outcomes than patients taking only clopidogrel. We sought to examine the effect of a PPI at discharge from the hospital after percutaneous coronary intervention with drug-eluting stents on the incidence of major adverse cardiac events (MACE) at 1 year. We compared 502 patients who were not prescribed a PPI at discharge and 318 patients who were prescribed a PPI. All patients were taking clopidogrel. We followed patients for 1 year with regard to MACE, including death, Q-wave myocardial infarction, target vessel revascularization, and stent thrombosis. We performed multivariate Cox regression to adjust for confounding variables, including compliance with clopidogrel, to assess the effect of a PPI at discharge on the 1-year outcomes. The baseline characteristics of patients discharged with a PPI were similar to those of patients discharged without a PPI. Univariate survival analysis of the outcomes showed a greater rate of MACE (13.8% vs 8.0%, p = 0.008) and overall mortality (4.7% vs 1.8%, p = 0.02) in the PPI group. After multivariate analysis, the adjusted MACE hazard ratio for PPI at discharge was 1.8 (95% confidence interval 1.1 to 2.7, p = 0.01). In conclusion, in patients undergoing percutaneous coronary intervention with drug-eluting stents and receiving clopidogrel, the prescription of a PPI at discharge was associated with a greater rate of MACE at 1 year.
Gaglia
Michael A
MA
Washington Hospital Center, Washington, District of Columbia.
Torguson
Rebecca
R
Hanna
Nicholas
N
Gonzalez
Manuel A
MA
Collins
Sara D
SD
Syed
Asmir I
AI
Ben-Dor
Itsik
I
Maluenda
Gabriel
G
Delhaye
Cedric
C
Wakabayashi
Kohei
K
Xue
Zhenyi
Z
Suddath
William O
WO
Kent
Kenneth M
KM
Satler
Lowell F
LF
Pichard
Augusto D
AD
Waksman
Ron
R
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000401:mortality; D001241:Aspirin / Q000627:therapeutic use; D000077144:Clopidogrel; D054855:Drug-Eluting Stents; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D054328:Proton Pump Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D015996:Survival Rate; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use
D010975:Platelet Aggregation Inhibitors; D054328:Proton Pump Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin