• Jaya Chandrasekhar, Sameer Bansilal, Usman Baber, Samantha Sartori, Melissa Aquino, Serdar Farhan, Birgit Vogel, Michela Faggioni, Gennaro Giustino, Cono Ariti, Antonio Colombo, Alaide Chieffo, Annapoorna Kini, Richard Saporito, Michael Gibson C C Harvard Medical School, Cambridge, Massachusetts., Bernhard Witzenbichler, David Cohen, David Moliterno, Thomas Stuckey, Timothy Henry, Stuart Pocock, George Dangas, Gabriel Steg P P Hôpital Bichat-Claude Bernard, Paris, France., and Roxana Mehran.
• Icahn School of Medicine at Mount Sinai, New York, New York.
• Catheter Cardiovasc Interv. 2017 Jun 1; 89 (7): E217-E225.

BackgroundProton pump inhibitors (PPI) may decrease the availability of clopidogrel by competitive antagonism, leading to a potential increase in ischemic events.MethodsWe evaluated patients from the all-comer PARIS registry treated with dual antiplatelet therapy (DAPT) with aspirin and clopidogrel following coronary stenting for outcomes stratified by PPI use. Two-year major adverse cardiovascular events (MACE), composite of cardiac death, myocardial infarction, definite or probable stent thrombosis or target lesion revascularization (TLR), and net adverse cardiac events (NACE), composite of MACE or Bleeding Academic Research consortium (BARC) type 3 or 5 bleeding were assessed. We also explored associations between PPI use and patterns of 2-year DAPT cessation.ResultsThe cohort comprised 4635 patients (23% PPI users) with mean age 64.4 ±11.4 years. Two year adjusted risk of MACE (HR: 1.27, 95% CI: 1.04-1.55), NACE (HR: 1.21, 95% CI: 1.01-1.44) and TLR (HR: 1.33, 95% CI: 1.04-1.71) were significantly higher in PPI users vs. non-users, without a difference in bleeding. Although the incidence of 2-year DAPT discontinuation and interruption was similar, DAPT disruption was significantly lower among PPI users vs. non-users (10.0% vs. 14.7%, P <0.0001). Compared to non-PPI users on continued DAPT, disruption was associated with higher MACE in both PPI users (HR: 2.34, 95% CI: 1.38-3.97) and non-users (HR: 1.41, 95% CI: 1.02-1.94) but greater BARC 3,5 bleeding only in non-PPI users (HR: 2.06, 95% CI: 1.21-3.51).ConclusionsIn clopidogrel treated PCI patients, the 2-year adjusted risk of MACE and NACE was significantly higher in PPI users driven by higher TLR compared to non-PPI users, without a difference in bleeding. PPI use was associated with lower incidence of DAPT disruption without an increase in disruption related bleeding compared to non-PPI users on DAPT. © 2016 Wiley Periodicals, Inc.© 2016 Wiley Periodicals, Inc.

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