Authors
Harjai KJ, Shenoy C, Orshaw P, Usmani S, Boura J, Mehta RH.
Title
Clinical outcomes in patients with the concomitant use of clopidogrel and proton pump inhibitors after percutaneous coronary intervention: an analysis from the Guthrie Health Off-Label Stent (GHOST) investigators.
References
Circ Cardiovasc Interv 2011;4:162-70.
Background
The concomitant use of proton pump inhibitors (PPIs) with clopidogrel is suspected to be associated with an adverse impact on clinical outcomes in patients with coronary artery disease.
Purpose
To evaluate whether the use of PPIs with clopidogrel was associated with worse clinical outcomes after percutaneous coronary intervention (PCI) compared with the use of clopidogrel alone.
Design
  • Prospective, observational registry
  • 2651 consecutive patients discharged alive after coronary stenting for stable or unstable coronary artery disease between 2001 and 2007.
  • Patients categorized into 2 groups: those taking a PPI [PPI (+), n=751] and those not taking a PPI [PPI (−), n=1900] at discharge.
  • Endpoints: 6-month Major Adverse Cardiovascular Events (MACE) defined as composite of death, MI, TVR, and stent thrombosis and 6-month Net Adverse Clinical Events (NACE) defined as the composite of MACE or hospitalization for Thrombolysis In MI (TIMI) major or minor bleeding.
Exclusion Criteria
  • Enrollment in a randomized trial of antiplatelet therapy
  • Discharge data on the use of PPI or dual antiplatelet therapy not available
  • Patient did not complete the 6-month follow-up
Follow-Up
6 months
Treatment Regimen
Successful PCI and stenting with antiplatelet therapy, with or without PPI
Results
Primary Endpoints:
  • Incidence of the primary and secondary study outcomes was similar in the PPI (+) and PPI (-) groups

Secondary Endpoints:

  • In survival analysis, no differences were seen between the groups with respect to time to first occurrence of MACE, NACE, TIMI (major or minor) bleeding, death, MI, death or MI, TVR, or stent thrombosis. In selected subsets, the incidence of MACE and NACE was similar between PPI (+) and PPI (-) patients.
Summary
The use of PPIs with dual antiplatelet therapy was not associated with any adverse influence on MACE or NACE after PCI.
Implications
This study suggests that the use of PPI may not influence major cardiovascular events. This registry data requires confirmation in randomized trials.
Related Figures
None.