Association of the use of proton pump inhibitors with adverse cardiovascular and bleeding outcomes after percutaneous coronary intervention in the Japanese real world clinical practice

  • Takeshi Kimura
  • Takeshi Morimoto
  • Yutaka Furukawa
  • Yoshihisa Nakagawa
  • Kazushige Kadota
  • Masashi Iwabuchi
  • Satoshi Shizuta
  • Hiroki Shiomi
  • Tomohisa Tada
  • Junichi Tazaki
  • Yoshihiro Kato
  • Mamoru Hayano
  • Mitsuru Abe
  • Takashi Tamura
  • Manabu Shirotani
  • Shinji Miki
  • Mitsuo Matsuda
  • Mamoru Takahashi
  • Katsuhisa Ishii
  • Masaru Tanaka
  • Takeshi Aoyama
  • Osamu Doi
  • Ryuichi Hattori
  • Ryozo Tatami
  • Satoru Suwa
  • Akinori Takizawa
  • Yoshiki Takatsu
  • Masaaki Takahashi
  • Hiroshi Kato
  • Teruki Takeda
  • Jong-Dae Lee
  • Ryuji Nohara
  • Chuwa Tei
  • Minoru Horie
  • Hirofumi Kambara
  • Hisayoshi Fujiwara
  • Kazuaki Mitsudo
  • Masakiyo Nobuyoshi
  • Toru Kita
Original Article

DOI: 10.1007/s12928-011-0063-2

Cite this article as:
Kimura, T., Morimoto, T., Furukawa, Y. et al. Cardiovasc Interv and Ther (2011) 26: 222. doi:10.1007/s12928-011-0063-2

Abstract

Previous studies have shown inconsistent results regarding the effects of concomitant use of clopidogrel and proton pump inhibitors (PPI) on cardiovascular outcomes. We sought to evaluate the clinical impact of PPI-use in patients treated with thienopyridines after percutaneous coronary intervention (PCI) in a large Japanese observational database. Among 12446 patients discharged alive on thienopyridines (ticlopidine 90.4% and clopidogrel 9.6%), 3223 patients were treated with PPIs and 9223 patients without PPI at the time of hospital discharge. The PPI group included more patients with co-morbidities than the non-PPI group. The adjusted hazard ratio (HR) of PPI-use for a composite of cardiovascular death, myocardial infarction, and stroke was 1.26 (95% confidence interval (CI) 1.09–1.47, p = 0.002). The adjusted HR of PPI-use for bleeding was 1.26 (95% CI 1.05–1.52, p = 0.013). Cardiovascular and bleeding outcomes were not different among the three groups receiving three different types of PPI. The negative effect of PPI on cardiovascular outcome was consistently seen in both drug-eluting stent (DES) [HR 1.31 (95% CI 1.07–1.6, p = 0.0097)] and non-DES strata [HR 1.25 (95% CI: 0.99–1.57, p = 0.057)] (Interaction p = 0.79) despite the fact that the duration of thienopyridine administration was significantly longer in patients receiving DES. In conclusion, cardiovascular outcomes after PCI were significantly worse in patients with PPI than in patients without PPI in the Japanese real clinical practice. However, the observed poorer cardiovascular outcome in patients receiving PPI was most likely to be related to residual confounding and seemed not causally related to attenuation of antiplatelet effect of thienopyridine through interaction with PPI.

Keywords

Stents Angioplasty Thrombus 

Supplementary material

12928_2011_63_MOESM1_ESM.doc (36 kb)
Supplementary material 1 (DOC 35 kb)
12928_2011_63_MOESM2_ESM.doc (30 kb)
Supplementary material 2 (DOC 30 kb)
12928_2011_63_MOESM3_ESM.doc (256 kb)
Supplementary material 3 (DOC 255 kb)

Copyright information

© Japanese Association of Cardiovascular Intervention and Therapeutics 2011

Authors and Affiliations

  • Takeshi Kimura
    • 1
  • Takeshi Morimoto
    • 2
  • Yutaka Furukawa
    • 3
  • Yoshihisa Nakagawa
    • 4
  • Kazushige Kadota
    • 5
  • Masashi Iwabuchi
    • 6
  • Satoshi Shizuta
    • 1
  • Hiroki Shiomi
    • 1
  • Tomohisa Tada
    • 1
  • Junichi Tazaki
    • 1
  • Yoshihiro Kato
    • 1
  • Mamoru Hayano
    • 1
  • Mitsuru Abe
    • 7
  • Takashi Tamura
    • 8
  • Manabu Shirotani
    • 9
  • Shinji Miki
    • 10
  • Mitsuo Matsuda
    • 11
  • Mamoru Takahashi
    • 12
  • Katsuhisa Ishii
    • 13
  • Masaru Tanaka
    • 14
  • Takeshi Aoyama
    • 15
  • Osamu Doi
    • 16
  • Ryuichi Hattori
    • 15
  • Ryozo Tatami
    • 17
  • Satoru Suwa
    • 18
  • Akinori Takizawa
    • 19
  • Yoshiki Takatsu
    • 20
  • Masaaki Takahashi
    • 21
  • Hiroshi Kato
    • 22
  • Teruki Takeda
    • 23
  • Jong-Dae Lee
    • 24
  • Ryuji Nohara
    • 25
  • Chuwa Tei
    • 26
  • Minoru Horie
    • 27
  • Hirofumi Kambara
    • 16
  • Hisayoshi Fujiwara
    • 20
  • Kazuaki Mitsudo
    • 5
  • Masakiyo Nobuyoshi
    • 6
  • Toru Kita
    • 3
  1. 1.Department of Cardiovascular MedicineGraduate School of Medicine, Kyoto UniversityKyotoJapan
  2. 2.Center for Medical Education and Clinical Epidemiology UnitGraduate School of Medicine, Kyoto UniversityKyotoJapan
  3. 3.Department of Cardiovascular MedicineKobe City Medical Center General HospitalKobeJapan
  4. 4.Division of CardiologyTenri HospitalTenriJapan
  5. 5.Division of CardiologyKurashiki Central HospitalKurashikiJapan
  6. 6.Division of CardiologyKokura Memorial HospitalKitakyushuJapan
  7. 7.Division of CardiologyKyoto Medical CenterKyotoJapan
  8. 8.Division of CardiologyJapanese Red Cross Wakayama Medical CenterWakayamaJapan
  9. 9.Division of CardiologyNara Hospital, Kinki University Faculty of MedicineIkomaJapan
  10. 10.Division of CardiologyMitsubishi Kyoto HospitalKyotoJapan
  11. 11.Division of CardiologyKishiwada City HospitalKishiwadaJapan
  12. 12.Division of CardiologyShimabara HospitalKyotoJapan
  13. 13.Division of CardiologyKansai Denryoku HospitalOsakaJapan
  14. 14.Division of CardiologyOsaka Red Cross HospitalOsakaJapan
  15. 15.Division of CardiologyShimada Municipal HospitalShimadaJapan
  16. 16.Division of CardiologyShizuoka General HospitalShizuokaJapan
  17. 17.Division of CardiologyMaizuru Kyosai HospitalMaizuruJapan
  18. 18.Division of CardiologyJuntendo University Shizuoka HospitalShizuokaJapan
  19. 19.Division of CardiologyShizuoka City HospitalShizuokaJapan
  20. 20.Division of CardiologyHyogo Prefectural Amagasaki HospitalAmagasakiJapan
  21. 21.Division of CardiologyHamamatsu Rosai HospitalHamamatsuJapan
  22. 22.Division of CardiologyNishi-Kobe Medical CenterKobeJapan
  23. 23.Division of CardiologyKoto Memorial HospitalHigashi-ohmiJapan
  24. 24.Division of CardiologyUniversity of Fukui HospitalFukuiJapan
  25. 25.Division of CardiologyKitano HospitalOsakaJapan
  26. 26.Department of Cardiovascular, Respiratory and Metabolic MedicineGraduate School of Medicine, Kagoshima UniversityKagoshimaJapan
  27. 27.Department of Cardiovascular and Respiratory MedicineShiga University of Medical Science HospitalOtsuJapan

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