Abstract 4542: Does Proton Pump Inhibitor Use Following Percutaneous Coronary Intervention With Drug-eluting Stents Impact Clinical Outcome?
Background: Proton pump inhibitors (PPIs) can alter the pharmacodynamic profile of clopidogrel and reduce its platelet inhibitory effects. Patients undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DES) are discharged with dual antiplatelet treatment (DAPT) with aspirin and clopidogrel. This study aimed to examine whether concurrent use of PPIs in these patients leads to in an increase in adverse cardiovascular outcomes.
Methods: The study population included 1896 patients who underwent PCI with DES who were discharged with DAPT for a minimum of 12 months. Of these, only 703 patients were prescribed with PPI. The clinical outcomes of patients who were and were not discharged on a PPI were compared at 12 months.
Results: Baseline characteristics detected a more complex and sicker population in the PPI group including more prior PCI, hypertension, hypercholesterolemia, renal insufficiency, current smokers, more diseased vessels and more prior history of coronary artery disease. The PPI group longer hospital stays (2.6±3.0 vs. 3.4±5.4 days, p<0.001) and experienced more in-hospital major bleeding (1.8% vs. 3.7%, p=0.009). The PPI group had more major adverse cardiac events (MACE as death, Q-wave myocardial infarction, or target vessel revascularization) at 12 months (10.3% vs. 15.3%, p=0.032), but similar cumulative stent thrombotic rates (0.6% vs. 0.9%, p=0.683). Multivariable, Cox regression analysis demonstrated PPI as the strongest predictor of MACE at 12 months. (Table⇓)
Conclusions: Patients who are discharged on PPI post-PCI with DES are sicker and prone to more adverse clinical events. These data do not dismiss the potential for a pharmacodynamic interaction with clopidogrel, however, this is not translated to an increase in stent thrombosis in a contemporary practice.