Impact of proton pump inhibitors and dual antiplatelet therapy cessation on outcomes following percutaneous coronary intervention

Results From the PARIS Registry Impact of Proton Pump Inhibitors and Dual Antiplatelet Therapy Cessation on Outcomes Following Percutaneous Coronary Intervention: Results From the PARIS Registry Impact of PPI Use and DAPT Cessation on PCI Outcomes Chandrasekhar et al.

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, C. Michael Gibson, Bernhard Witzenbichler, David Cohen, David Moliterno, Thomas Stuckey, Timothy Henry & 4 others Stuart Pocock, George Dangas, P. Gabriel Steg, Roxana Mehran

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

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 <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). Conclusions: In 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.

Original languageEnglish
JournalCatheterization and Cardiovascular Interventions
DOIs
Publication statusAccepted/In press - 2016

Fingerprint

Proton Pump Inhibitors
Percutaneous Coronary Intervention
Registries
clopidogrel
Hemorrhage
Therapeutics
Incidence
Research
Aspirin
Stents
Thrombosis
Myocardial Infarction

Keywords

  • Dual antiplatelet therapy cessation
  • P2Y12 receptor inhibitor
  • Percutaneous coronary intervention
  • Proton pump inhibitor
  • Thienopyridine

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Impact of proton pump inhibitors and dual antiplatelet therapy cessation on outcomes following percutaneous coronary intervention : Results From the PARIS Registry Impact of Proton Pump Inhibitors and Dual Antiplatelet Therapy Cessation on Outcomes Following Percutaneous Coronary Intervention: Results From the PARIS Registry Impact of PPI Use and DAPT Cessation on PCI Outcomes Chandrasekhar et al. / 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.

In: Catheterization and Cardiovascular Interventions, 2016.

Research output: Contribution to journalArticle

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. / Impact of proton pump inhibitors and dual antiplatelet therapy cessation on outcomes following percutaneous coronary intervention : Results From the PARIS Registry Impact of Proton Pump Inhibitors and Dual Antiplatelet Therapy Cessation on Outcomes Following Percutaneous Coronary Intervention: Results From the PARIS Registry Impact of PPI Use and DAPT Cessation on PCI Outcomes Chandrasekhar et al. In: Catheterization and Cardiovascular Interventions. 2016.
@article{bada9058566f44f0bec4c488b1c928c4,
title = "Impact of proton pump inhibitors and dual antiplatelet therapy cessation on outcomes following percutaneous coronary intervention: Results From the PARIS Registry Impact of Proton Pump Inhibitors and Dual Antiplatelet Therapy Cessation on Outcomes Following Percutaneous Coronary Intervention: Results From the PARIS Registry Impact of PPI Use and DAPT Cessation on PCI Outcomes Chandrasekhar et al.",
abstract = "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 <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). Conclusions: In 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.",
keywords = "Dual antiplatelet therapy cessation, P2Y12 receptor inhibitor, Percutaneous coronary intervention, Proton pump inhibitor, Thienopyridine",
author = "Jaya Chandrasekhar and Sameer Bansilal and Usman Baber and Samantha Sartori and Melissa Aquino and Serdar Farhan and Birgit Vogel and Michela Faggioni and Gennaro Giustino and Cono Ariti and Antonio Colombo and Alaide Chieffo and Annapoorna Kini and Richard Saporito and {Michael Gibson}, C. and Bernhard Witzenbichler and David Cohen and David Moliterno and Thomas Stuckey and Timothy Henry and Stuart Pocock and George Dangas and {Gabriel Steg}, P. and Roxana Mehran",
year = "2016",
doi = "10.1002/ccd.26716",
language = "English",
journal = "Catheterization and Cardiovascular Interventions",
issn = "1522-1946",
publisher = "John Wiley and Sons Inc.",

}

TY - JOUR

T1 - Impact of proton pump inhibitors and dual antiplatelet therapy cessation on outcomes following percutaneous coronary intervention

T2 - Results From the PARIS Registry Impact of Proton Pump Inhibitors and Dual Antiplatelet Therapy Cessation on Outcomes Following Percutaneous Coronary Intervention: Results From the PARIS Registry Impact of PPI Use and DAPT Cessation on PCI Outcomes Chandrasekhar et al.

AU - Chandrasekhar, Jaya

AU - Bansilal, Sameer

AU - Baber, Usman

AU - Sartori, Samantha

AU - Aquino, Melissa

AU - Farhan, Serdar

AU - Vogel, Birgit

AU - Faggioni, Michela

AU - Giustino, Gennaro

AU - Ariti, Cono

AU - Colombo, Antonio

AU - Chieffo, Alaide

AU - Kini, Annapoorna

AU - Saporito, Richard

AU - Michael Gibson, C.

AU - Witzenbichler, Bernhard

AU - Cohen, David

AU - Moliterno, David

AU - Stuckey, Thomas

AU - Henry, Timothy

AU - Pocock, Stuart

AU - Dangas, George

AU - Gabriel Steg, P.

AU - Mehran, Roxana

PY - 2016

Y1 - 2016

N2 - 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 <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). Conclusions: In 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.

AB - 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 <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). Conclusions: In 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.

KW - Dual antiplatelet therapy cessation

KW - P2Y12 receptor inhibitor

KW - Percutaneous coronary intervention

KW - Proton pump inhibitor

KW - Thienopyridine

UR - http://www.scopus.com/inward/record.url?scp=84988405270&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84988405270&partnerID=8YFLogxK

U2 - 10.1002/ccd.26716

DO - 10.1002/ccd.26716

M3 - Article

JO - Catheterization and Cardiovascular Interventions

JF - Catheterization and Cardiovascular Interventions

SN - 1522-1946

ER -