Abstract 4324: Proton Pump Inhibitors Increase Major Adverse Cardiac Events Among Post Percutaneous Coronary Intervention Patients on Clopidogrel
Background: There has been increased publicity around the attenuating effects of proton pump inhibitors (PPI) on clopidogrel presumed to be mainly from CYP2C19 enzyme competitive inhibition. Recent studies have shown conflicting results however. We hypothesize that PPIs increase adverse event rates in post percutaneous coronary intervention (PCI) patients on clopidogrel.
Methods: This is a single institution retrospective case-control study of 1192 patients on clopidogrel who underwent PCI from January 1, 2004 to March 1, 2007. Univariate and multivariate analyses determined if PPIs affected major adverse cardiac events (MACE) in post PCI patients during nine months follow-up. MACE included recurrent MI, repeat revascularization and death.
Results: Of 1192 patients on clopidogrel, 36% (N=429) were on PPI and 64% (N=763) were not. The PPI group was constituted of 45.5% (N=195) lansoprazole, 32.2% (N=138) pantoprazole, 12.1% (N=52) omeprazole, and 10.3% (N=44) esomeprazole. At nine months follow-up, there were significantly more deaths (3.7% vs 1.4%; p=0.011) and MACE (8.2% vs 4.2%; p=0.004) in the PPI group compared to the without PPI group. With adjustment of variables including age, sex, use of GP2b3a inhibitors, and stent size, Cox regression revealed that PPI at discharge is an independent predictor of MACE at nine months follow-up (p=0.024, odds ratio, 1.761, 95% CI, 1.078 –2.876). Overall log rank test showed no significant difference among different PPIs on nine-month MACE.
Conclusion: Concomitant use of PPIs and clopidogrel among post PCI patients significantly increased rates of death and major adverse cardiac events at nine months follow-up.