Key result
Intermittent use of proton pump inhibitors was associated with a significantly lower risk of major adverse cardiac events (HR 0.293) compared to sustained use in patients with coronary heart disease on clopidogrel.
Why the study?
The clinical impact of concurrent PPIs and antiplatelet therapy to prevent gastrointestinal bleeding in patients with CHD remains under debate, particularly in Asian populations.
Does intermittent concurrent use of PPIs and clopidogrel reduce adverse clinical outcomes compared to sustained PPI use in Chinese patients with CHD?
Cohort (n=638)
No
Does intermittent concurrent use of PPIs and clopidogrel reduce adverse clinical outcomes compared to sustained PPI use in Chinese patients with CHD?
Hazard Ratio: 0.293 (95% CI 0.119–0.722)
Absolute Event Rate: 5.3% vs 11.4%
p-value: p=0.008
Intermittent concurrent use of PPIs and clopidogrel is associated with a lower risk of MACE and NACE compared to sustained PPI use in Chinese patients with CHD.
Caution against changing PPI use with clopidogrel from this data alone; leaves open need for prospective Asian trials.
BACKGROUND: Proton pump inhibitors (PPIs) are frequently prescribed to patients with coronary heart disease (CHD) under antiplatelet therapy to prevent gastrointestinal (GI) bleeding. However, its clinical impact is still under debate, especially in Asian population. This study was undertaken to explore the effects of concurrent use of clopidogrel and PPIs on the clinical outcomes in Chinese patients with CHD in secondary prevention. METHODS: A single-center retrospective study was conducted in 638 patients with CHD on consecutive clopidogrel therapy for at least 1 year. After 18-month follow-up, adverse clinical events were collected. Cox regression was used to calculate hazard ratios (HR) and 95% confidence interval (CI) for the effect of PPI use on the outcomes. A total of 638 patients were recruited from 2014 to 2015 in this study, among whom 201 were sustained PPI users, 188 were intermittent PPI users and the remaining 249 were non-PPI users. RESULTS: Compared with sustained PPI users, intermittent use of PPIs was associated with a lower risk of stroke, major adverse cardiac events (MACE) and net adverse clinical event (NACE) (stroke: adjusted HR: 0.109, 95% CI 0.014-0.878, p = 0.037; MACE: adjusted HR: 0.293, 95% CI 0.119-0.722; p = 0.008; NACE: adjusted HR: 0.357, 95% CI 0.162-0.786, p = 0.011). Subgroup analysis further revealed the benefit of intermittent PPI use was significant in male CHD patients over 60 years old, with hypertension or chronic kidney disease, and undergoing percutaneous coronary intervention during hospitalization. CONCLUSION: The current findings suggest that the intermittent concurrent use of PPIs and clopidogrel is not associated with an increased risk of 18-month adverse clinical outcomes, and intermittent use of PPIs is associated with a lower rate of MACE and NACE.
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He et al. (2021) conducted a cohort in Coronary artery disease (n=638). Intermittent use of proton pump inhibitors vs. Sustained use of proton pump inhibitors was evaluated on Major adverse cardiac events (MACE) (HR 0.293, 95% CI 0.119-0.722, p=0.008). Intermittent use of proton pump inhibitors was associated with a significantly lower risk of major adverse cardiac events (HR 0.293) compared to sustained use in patients with coronary heart disease on clopidogrel.
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