Impact of concomitant use of proton pump inhibitors and clopidogrel or ticagrelor on clinical outcomes in patients with acute coronary syndrome.
BACKGROUND
There is great debate on the possible adverse interaction between proton pump inhibitors (PPIs) and clopidogrel. In addition, whether the use of PPIs affects the clinical efficacy of ticagrelor remains less known. We aimed to determine the impact of concomitant administration of PPIs and clopidogrel or ticagrelor on clinical outcomes in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI).


METHODS
We retrospectively analyzed data from a "real world", international, multi-center registry between 2003 and 2014 (n = 15,401) and assessed the impact of concomitant administration of PPIs and clopidogrel or ticagrelor on 1-year composite primary endpoint (all-cause death, re-infarction, or severe bleeding) in patients with ACS after PCI.


RESULTS
Of 9429 patients in the final cohort, 54.8% (n = 5165) was prescribed a PPI at discharge. Patients receiving a PPI were older, more often female, and were more likely to have comorbidities. No association was observed between PPI use and the primary endpoint for patients receiving clopidogrel (adjusted HR: 1.036; 95% CI: 0.903-1.189) or ticagrelor (adjusted HR: 2.320; 95% CI: 0.875-6.151) (P interaction = 0.2004). Similarly, use of a PPI was not associated with increased risk of all-cause death, re-infarction, or a decreased risk of severe bleeding for patients treated with either clopidogrel or ticagrelor.


CONCLUSIONS
In patients with ACS following PCI, concomitant use of PPIs was not associated with increased risk of adverse outcomes in patients receiving either clopidogrel or ticagrelor. Our findings indicate it is reasonable to use a PPI in combination with clopidogrel or ticagrelor, especially in patients with a higher risk of gastrointestinal bleeding.
Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Yan
Y
Yan
Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Xiao
X
Wang
Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Jing-Yao
JY
Fan
Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Shao-Ping
SP
Nie
University Hospital Álvaro Cunqueiro, Vigo, Spain.
Sergio
S
Raposeiras-Roubín
University Hospital Álvaro Cunqueiro, Vigo, Spain.
Emad
E
Abu-Assi
University Academic Medical Center, Amsterdam, the Netherlands.
Jose P Simao
JP
Henriques
Dipartimento di Scienze Mediche, Divisione di Cardiologia, Città della Salute e della Scienza, Turin, Italy.
Fabrizio
F
D'Ascenzo
NorthShore University Hospital, Chicago, USA.
Jorge
J
Saucedo
University Clinical Hospital of Santiago de Compostela, Spain.
José R
JR
González-Juanatey
Libin Cardiovascular Institute of Alberta, Calgary, Canada.
Stephen B
SB
Wilton
University Academic Medical Center, Amsterdam, the Netherlands.
Wouter J
WJ
Kikkert
San Carlos Hospital, Madrid, Spain.
Iván
I
Nuñez-Gil
Bellvitge Hospital, Barcelona, Spain.
Albert
A
Ariza-Sole
Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Xian-Tao
XT
Song
University Patras Hospital, Athens, Greece.
Dimitrios
D
Alexopoulos
Kerckhoff Heart and Thorax Center, Frankfurt, Germany.
Christoph
C
Liebetrau
Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Tetsuma
T
Kawaji
Dipartimento di Scienze Mediche, Divisione di Cardiologia, Città della Salute e della Scienza, Turin, Italy.
Claudio
C
Moretti
University Clinical Hospital, Warsaw, Poland.
Zenon
Z
Huczek
Tokai University School of Medicine, Tokyo, Japan.
Toshiharu
T
Fujii
Hospital Sao Rafael, Salvador, Brazil.
Luis C
LC
Correia
Kanazawa University Graduate School of Medicine, Kanazawa, Japan.
Masa-Aki
MA
Kawashiri
University Clinic of Cardiology, Skopje, Macedonia.
Sasko
S
Kedev
Acute coronary syndrome; Clopidogrel; Outcome; Proton pump inhibitor; Ticagrelor