Key result
Concomitant PPI use in patients on clopidogrel after drug-eluting stent implantation was associated with increased risk of major adverse cardiac events (HR 1.21; 95% CI 1.04-1.42; P=0.02).
Why the study?
Does concomitant proton pump inhibitor use increase high platelet reactivity and adverse cardiovascular outcomes in patients treated with clopidogrel after drug-eluting stent implantation?
Cohort (n=8,582)
Yes
Does concomitant proton pump inhibitor use increase high platelet reactivity and adverse cardiovascular outcomes in patients treated with clopidogrel after drug-eluting stent implantation?
Concomitant PPI use in patients treated with clopidogrel after DES implantation is associated with higher platelet reactivity and an increased risk of major adverse cardiac events.
Answers are grounded in this paper and cite their sources.
PPI use was associated with higher reactivity and events post-PCI; hypothesis-generating and should not yet change practice.
BACKGROUND: Certain proton pump inhibitors (PPIs) interfere with clopidogrel metabolism, potentially attenuating P2Y12 receptor inhibition. Previous observational and randomized trials report conflicting results regarding the clinical significance of this pharmacological interaction. We examined the interaction between concomitant administration of PPI and clopidogrel on platelet reactivity and clinical outcomes in the large-scale, prospective Assessment of Dual AntiPlatelet Therapy With Drug-Eluting Stents study. METHODS AND RESULTS: On-treatment P2Y12 platelet reactivity testing was performed using the VerifyNow assay after clopidogrel loading and successful drug-eluting stent implantation at 11 sites in the United States and Germany. PPIs were prescribed at the discretion of treating physicians; patients were followed for 2 years. High platelet reactivity was defined as P2Y12 reactivity units >208. Of 8582 enrolled patients, 2697 (31.4%) were taking a PPI at the time of coronary intervention. After adjustment for differences in baseline characteristics, PPI use was independently associated with high platelet reactivity (odds ratio, 1.38: 95% confidence interval, 1.25-1.52, P=0.0001). A total of 2162 (25.2%) patients were prescribed a PPI at hospital discharge. In a propensity-adjusted multivariable analysis, discharge PPI use was independently associated with increased risk for postdischarge major adverse cardiac events (cardiac death, myocardial infarction, or ischemia-driven target lesion revascularization) at 2-year follow-up (hazard ratio, 1.21; 95% confidence interval, 1.04-1.42, P=0.02). CONCLUSIONS: In patients treated with clopidogrel after successful drug-eluting stents implantation, the concomitant administration of PPI was associated with high platelet reactivity and a greater rate of adverse outcomes during long-term follow-up. Additional studies are warranted to determine the risk-benefit ratio of PPIs in patients with drug-eluting stents treated with clopidogrel. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00433966.
No takes yet. Share an insight, caveat, or question.
Weisz et al. (2015) conducted a cohort in Drug-eluting stent implantation treated with clopidogrel (n=8,582). Proton pump inhibitors vs. No proton pump inhibitor was evaluated on Major adverse cardiac events (cardiac death, myocardial infarction, or ischemia-driven target lesion revascularization) (HR 1.21, 95% CI 1.04-1.42, p=0.02). Concomitant PPI use in patients on clopidogrel after drug-eluting stent implantation was associated with increased risk of major adverse cardiac events (HR 1.21; 95% CI 1.04-1.42; P=0.02).
Synapse has enriched 10 related papers. Consider them for comparative context: