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. 2012:2012:692761.
doi: 10.5402/2012/692761. Epub 2012 Jun 27.

Impact of dual antiplatelet therapy with proton pump inhibitors on the outcome of patients with acute coronary syndrome undergoing drug-eluting stent implantation

Francesca Macaione  1 , Carla Montaina, Salvatore Evola, Giuseppina Novo, Salvatore Novo
Affiliations

Impact of dual antiplatelet therapy with proton pump inhibitors on the outcome of patients with acute coronary syndrome undergoing drug-eluting stent implantation

Francesca Macaione et al. ISRN Cardiol. 2012.

Abstract

This study aimed to assess if proton pump inhibitors (PPIs) may reduce the effectiveness of clopidogrel, than H2 antagonist (anti-H2) in order to determine rehospitalization for acute coronary syndrome (re-ACS), target vessel revascularization (TVR) and cardiac death. This case-control study included 176 patients with ACS undergoing angioplasty (PCI) with drug-eluting stent implantation. The population was divided into two groups: PPI group (n = 121) consisting of patients receiving at discharge dual antiplatelet therapy (DAT) plus PPI and anti-H2 group (n = 55), consisting of patients receiving at discharge DAT + H2 receptor antagonist (H2RA). In a followup of 36 months the prevalence of ACS event (P = 0.014), TVR (P = 0.031) was higher in the PPI group than in the anti-H2 group; instead there was no statistically significant difference between groups for death. The variables independently associated with ACS were the diabetes, omeprazole, and esomeprazole; instead the variables independently associated with TVR were only omeprazole. Our data shows that the use of omeprazole and esomeprazole, with clopidogrel, is associated with increased risk of adverse outcomes after PCI with drug-eluting stent implantation.

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Figures

Figure 1
Figure 1
Prevalence of proton pump inhibitors in the PPIs group.
Figure 2
Figure 2
ACS and TVR events correlated at the use of PPI individually and of anti-H2. re-ACS: rehospitalization for acute coronary syndrome; TVR: target vessel revascularization.
See this image and copyright information in PMC

References

    1. Iakovou I, Schmidt T, Bonizzoni E, et al. Incidence, predictors and outcome of thrombosis after succesful implantation of drug-eluting stents. JAMA. 2005;293(17):2126–2130. - PubMed
    1. Grines CL, Bonow RO, Casey DE, et al. Prevention of premature discontinuation of dual antiplatelet therapy in patients with coronary artery stents: a science advisory from the American Heart Association, American College of Cardiology, Society for Cardiovascular Angiography and Interventions, American College of Surgeons, and American Dental Association, with representation from the American College of Physicians. Circulation. 2007;115(6):813–818. - PubMed
    1. Yusuf S, Zhao F, Mehta SR, Chrolavicius S, Tognoni G, Fox KK. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. The New England Journal of Medicine. 2001;345(7):494–502. - PubMed
    1. Chan FKL, Ching JYL, Hung LCT. Clopidogrel versus aspirin and esomeprazole to prevent recurrent ucler bleeding. The New England Journal of Medicine. 2005;352(3):338–344. - PubMed
    1. Ho PM, Maddox TM, Wang L. Risk of adverse outcomes associated with concomitant use of clopidogrel and proton pump inhibitors following acute coronary syndrome. JAMA. 2009;301(9):937–944. - PubMed

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