P0456 - Systematic Review With Meta-Analysis: Influence of Individual Proton Pump Inhibitors on Clinical Outcomes in Patients Receiving Clopidogrel Following Percutaneous Coronary Intervention

Award: Presidential Poster Award

Award: Presidential Poster Award

Beom Jin Kim, MD, PhD¹, Dongyoung Lee, MD^2
1Chung-Ang University College of Medicine, Seoul, Seoul-t'ukpyolsi, Republic of Korea; ²Wonkwang University College of Medicine, Sanbon, Kyonggi-do, Republic of Korea

Introduction: Data are conflicting on whether proton pump inhibitors (PPIs) diminish the efficacy of clopidogrel. We investigated individual PPIs and adverse cardiovascular events in post percutaneous coronary intervention (PCI) patients on dual antiplatelet therapy (DAPT) with clopidogrel.

Methods: We searched Ovid-MEDLINE, EMBASE, and Cochrane from inception to March 2020 to identify studies that evaluated the efficacy and safety of clopidogrel added PPIs vs. clopidogrel only in post-PCI patient. We extracted data from 28 studies for major adverse cardiovascular endpoints (MACE), myocardial infarction (MI), cardiovascular death, and gastrointestinal bleeding. Risk ratios (RR) and hazard ratios (HR) were pooled separately.

Results: Data were extracted on 131412 patients from the 28 studies included. Concomitant use of PPI with clopidogrel was associated with increased risk of MACE (RR 1.32; 95% CI 1.16–1.49; P < .001) and MI (RR 1.45; 95% CI 1.26–1.67; P = .002). Subgroup analysis with individual PPIs demonstrated an increased risk of MACE in those taking pantoprazole (RR 1.31; 95% CI 1.07–1.61, P = .01) or lansoprazole (RR 1.41; 95% CI 1.19–1.68, P < .0001) compared with patients not on PPIs. Likewise, in adjusted analyses, the pooled hazard ratios of adjusted events for MACEs showed that the increased risk of MACEs was similar for four classes of PPIs but not for rabeprazole (HR: 1.32; 95% CI 0.69–2.53, P = .40).

Discussion: The post PCI patients on DAPT with clopidogrel in the PPI group were associated with higher risk of MACE and MI. Although the results for rabeprazole were not robust, it was the only PPI that did not yield a significantly increased risk of MACE.



Disclosures:


Beom Jin Kim, MD, PhD¹, Dongyoung Lee, MD². P0456 - Systematic Review With Meta-Analysis: Influence of Individual Proton Pump Inhibitors on Clinical Outcomes in Patients Receiving Clopidogrel Following Percutaneous Coronary Intervention, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.