Impact of proton pump inhibitors and dual antiplatelet therapy cessation on outcomes following percutaneous coronary intervention: Results From the PARIS Registry

• Published in: Catheterization and cardiovascular interventions 2017-06, Vol.89 (7), p.E217-E225
• Main Authors: Chandrasekhar, Jaya, Bansilal, Sameer, Baber, Usman, Sartori, Samantha, Aquino, Melissa, Farhan, Serdar, Vogel, Birgit, Faggioni, Michela, Giustino, Gennaro, Ariti, Cono, Colombo, Antonio, Chieffo, Alaide, Kini, Annapoorna, Saporito, Richard, Michael Gibson, C., Witzenbichler, Bernhard, Cohen, David, Moliterno, David, Stuckey, Thomas, Henry, Timothy, Pocock, Stuart, Dangas, George, Gabriel Steg, P., Mehran, Roxana
• Format: Article
• Language: English
• Subjects: Aged; Angioplasty; Antagonism; Antiplatelet therapy; Aspirin; Aspirin - administration & dosage; Aspirin - adverse effects; Bleeding; Clopidogrel; Coronary Thrombosis - etiology; Death; Drug Administration Schedule; Drug Antagonism; Drug Therapy, Combination; dual antiplatelet therapy cessation; Europe; Female; Heart; Heart diseases; Hemorrhage - chemically induced; Humans; Implants; Incidence; Inhibitors; Interruption; Ischemia; Kaplan-Meier Estimate; Male; Middle Aged; Myocardial infarction; Myocardial Infarction - etiology; Myocardial Ischemia - diagnosis; Myocardial Ischemia - mortality; Myocardial Ischemia - therapy; P2Y12 receptor inhibitor; percutaneous coronary intervention; Percutaneous Coronary Intervention - adverse effects; Percutaneous Coronary Intervention - instrumentation; Percutaneous Coronary Intervention - mortality; Platelet Aggregation Inhibitors - administration & dosage; Platelet Aggregation Inhibitors - adverse effects; Proportional Hazards Models; Prospective Studies; proton pump inhibitor; Proton pump inhibitors; Proton Pump Inhibitors - administration & dosage; Proton Pump Inhibitors - adverse effects; Registries; Risk assessment; Risk Factors; Stents; thienopyridine; Thromboembolism; Thrombosis; Ticlopidine - administration & dosage; Ticlopidine - adverse effects; Ticlopidine - analogs & derivatives; Time Factors; Treatment Outcome; United States
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/ccd.26716

Background Proton pump inhibitors (PPI) may decrease the availability of clopidogrel by competitive antagonism, leading to a potential increase in ischemic events. Methods We 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. Results The 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