Key result
Proton pump inhibitors with clopidogrel were associated with a higher prevalence of ACS events (P=0.014) and target vessel revascularization (P=0.031) compared to H2 antagonists after PCI.
Why the study?
Does dual antiplatelet therapy with proton pump inhibitors compared to H2 antagonists increase the risk of rehospitalization for ACS, TVR, and cardiac death in patients with ACS undergoing PCI with drug-eluting stents?
Case-Control (n=176)
Does dual antiplatelet therapy with proton pump inhibitors compared to H2 antagonists increase the risk of rehospitalization for ACS, TVR, and cardiac death in patients with ACS undergoing PCI with drug-eluting stents?
p-value: p=0.014 for ACS event, 0.031 for TVR
The concomitant use of omeprazole or esomeprazole with clopidogrel in ACS patients post-PCI is associated with an increased risk of recurrent ACS and target vessel revascularization compared to H2 antagonists.
May suggest preferring H2 antagonists over PPIs with clopidogrel post-PCI; hypothesis-generating and requires RCTs before practice change.
This study aimed to assess if proton pump inhibitors (PPIs) may reduce the effectiveness of clopidogrel, than H2 antagonist (anti-H2) in order to determine rehospitalization for acute coronary syndrome (re-ACS), target vessel revascularization (TVR) and cardiac death. This case-control study included 176 patients with ACS undergoing angioplasty (PCI) with drug-eluting stent implantation. The population was divided into two groups: PPI group (n = 121) consisting of patients receiving at discharge dual antiplatelet therapy (DAT) plus PPI and anti-H2 group (n = 55), consisting of patients receiving at discharge DAT + H2 receptor antagonist (H2RA). In a followup of 36 months the prevalence of ACS event (P = 0.014), TVR (P = 0.031) was higher in the PPI group than in the anti-H2 group; instead there was no statistically significant difference between groups for death. The variables independently associated with ACS were the diabetes, omeprazole, and esomeprazole; instead the variables independently associated with TVR were only omeprazole. Our data shows that the use of omeprazole and esomeprazole, with clopidogrel, is associated with increased risk of adverse outcomes after PCI with drug-eluting stent implantation.
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Macaione et al. (2012) conducted a case-control in Acute Coronary Syndrome (n=176). Proton pump inhibitors (PPIs) vs. H2 receptor antagonist (H2RA) was evaluated on rehospitalization for acute coronary syndrome (re-ACS), target vessel revascularization (TVR) and cardiac death (p=0.014 for ACS event, 0.031 for TVR). Proton pump inhibitors with clopidogrel were associated with a higher prevalence of ACS events (P=0.014) and target vessel revascularization (P=0.031) compared to H2 antagonists after PCI.
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