Abstract 4323: Mortality Associated With Proton Pump Inhibitors Following Percutaneous Coronary Interventions With Drug Eluting Stents
Background: Proton pump inhibitors (PPIs) are frequently co-administered with aspirin and clopidogrel as gastrointestinal prophylaxis following percutaneous coronary interventions (PCI). PPIs have been reported to variably inhibit cytochromes P4503A4 and CYP2C19 and data suggest they reduce the efficacy of clopidogrel.
Methods: We conducted a retrospective cohort study of 8,311 consecutive patients who underwent PCI with drug eluting stents (DES) between April 2003 and June 2007 and were followed through June 30, 2008. The primary outcome of all-cause mortality was identified using the New York State Interventional database and the Social Security Death Index. Secondary outcomes included 30-day stent thrombosis and target lesion revascularization (TLR) following PCI.
Results: Overall, 17% of patients (n=1,385) were taking PPIs. Raberprazole was not included in this analysis due to the low number of patients on this drug (n=37). Over a mean 2 years of follow-up (maximum follow-up=5.4 years), 602 patients died. The mortality rate was higher among patients taking, compared to those not taking, PPIs (53.5 and 33.0 deaths per 1,000 person-years, respectively; p<0.001). After multivariable adjustment, the hazard ratio of mortality associated with taking PPIs was 1.30 (95% CI: 1.06 –1.60). Compared to patients not taking PPIs, the multivariable adjusted hazard ratios among patients taking omeprazole and pantoprazole were increased (table⇓). PPI use was associated with a non-significant increased risk of 30-day stent thrombosis and TLR following PCI.
Conclusion: PPI use was associated with increased all-cause mortality following PCI with a DES. Of the PPIs evaluated, omeprazole and pantoprazole were both associated with increased mortality.