title: Proton pump inhibitors and other disease-based factors in the recurrence of adverse cardiovascular events following percutaneous coronary angiography: A long-term cohort.
abstract: BACKGROUND
  Dual aspirin-clopidogrel antiplatelet therapy (DAPT) has been shown to decrease the risk of adverse cardiac events after percutaneous coronary intervention (PCI). Proton pump inhibitors (PPIs) are used in these patients to decrease the risk of gastrointestinal bleeding and several studies have reported potential interaction and conflicting clinical outcomes with their use. We aim to assess the effect of different PPIs and other factors on the recurrence of cardiovascular (CV) events in patients following PCI.
  
  
  METHODS
  We performed a retrospective cohort on patients who underwent PCI in the last 5 years and were discharged with or without PPIs. Strict inclusion criteria were adopted, outcome measures were defined, and patient follow up up to 2 years was collected.
  
  
  RESULTS
  Out of 740 patients, 453 (61.2 %) had received PPIs and 287 (38.8 %) were discharged without PPIs. Ninety-five (12.8 %) patients were readmitted due to adverse CV events. Statistically, there was no significant difference in the recurrence of CV events with the use of different PPIs (p = 0.384) and PPI use had an overall protective effect (p = 0.009, HR 0.58 (CI 0.39-0.88). Patients with history of diabetes mellitus (p = 0.048) had an increased risk of adverse CV events.
  
  
  CONCLUSIONS
  We conclude that pharmacokinetic interaction between PPIs and antiplatelet therapy is not associated with adverse CV events. A comprehensive, multicenter, open-label trial including all PPI subclasses and patient and disease-based factors is warranted for a fair evaluation.
authors.affiliation: Department of Medicine, Aga Khan University Hospital, Stadium Road, Karachi, Sindh, Pakistan.
authors.forename: Adil
authors.initials: A
authors.lastname: Ayub
authors.affiliation: Department of Medicine, Aga Khan University Hospital, Stadium Road, Karachi, Sindh, Pakistan. om.parkash@aku.edu.
authors.forename: Om
authors.initials: O
authors.lastname: Parkash
authors.affiliation: Department of Medicine, Aga Khan University Hospital, Stadium Road, Karachi, Sindh, Pakistan.
authors.forename: Buria
authors.initials: B
authors.lastname: Naeem
authors.affiliation: Department of Medicine, Aga Khan University Hospital, Stadium Road, Karachi, Sindh, Pakistan.
authors.forename: Duraiz
authors.initials: D
authors.lastname: Murtaza
authors.affiliation: Department of Medicine, Aga Khan University Hospital, Stadium Road, Karachi, Sindh, Pakistan.
authors.forename: Aamir Hameed
authors.initials: AH
authors.lastname: Khan
authors.affiliation: Department of Medicine, Aga Khan University Hospital, Stadium Road, Karachi, Sindh, Pakistan.
authors.forename: Wasim
authors.initials: W
authors.lastname: Jafri
authors.affiliation: Department of Medicine, Aga Khan University Hospital, Stadium Road, Karachi, Sindh, Pakistan.
authors.forename: Saeed
authors.initials: S
authors.lastname: Hamid
mesh_terms: D000368:Aged; D001241:Aspirin / Q000008:administration & dosage / Q000009:adverse effects; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000517:prevention & control*; D000077144:Clopidogrel; D015331:Cohort Studies; D004338:Drug Combinations; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D054328:Proton Pump Inhibitors / Q000008:administration & dosage*; D012008:Recurrence; D012189:Retrospective Studies; D012306:Risk; D013988:Ticlopidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives; D013997:Time Factors
chemical_list: D004338:Drug Combinations; D010975:Platelet Aggregation Inhibitors; D054328:Proton Pump Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin
keywords: Clopidogrel; Dual antiplatelet therapy; Proton pump inhibitors