According to research published early online in the American Journal of Cardiology, patients who received drug-eluting coronary stents and took clopidogrel had an increased risk of major adverse cardiac events if they were also taking a proton pump inhibitor (PPI).

Researchers sought to examine the effect of a PPI at discharge from the hospital after percutaneous coronary intervention with drug-eluting stents on the incidence of major adverse cardiac events (MACE) at 1 year. The study involved a total of 820 patients of whom 502 patients were not prescribed a PPI at discharge and 318 patients who were prescribed a PPI. All patients were taking clopidogrel, and followed up for 1 year.

The following results were reported:

• Univariate survival analysis of the outcomes showed a greater rate of MACE (13.8% vs 8.0%, p = 0.008) and overall mortality (4.7% vs 1.8%, p = 0.02) in the PPI group, compared to those not on a PPI
• After multivariate analysis, the adjusted MACE hazard ratio for PPI at discharge was 1.8 (95% confidence interval 1.1 to 2.7, p = 0.01).

The researchers concluded that in patients undergoing percutaneous coronary intervention with drug-eluting stents and receiving clopidogrel, the prescription of a PPI at discharge was associated with a greater rate of MACE at 1 year.

[Editor’s note: The US FDA and the MHRA had recently issued practical advice with respect to this interaction – Please see links below]