Table of Contents
ISRN Cardiology
Volume 2012, Article ID 692761, 8 pages
http://dx.doi.org/10.5402/2012/692761
Clinical Study

Impact of Dual Antiplatelet Therapy with Proton Pump Inhibitors on the Outcome of Patients with Acute Coronary Syndrome Undergoing Drug-Eluting Stent Implantation

Division of Cardiology and Post-Graduate School of Cardiology, Center for the Early Diagnosis of Preclinical and Multifocal Atherosclerosis and for the Secondary Prevention, University Hospital “P. Giaccone” of the University of Palermo, 127-90127 Palermo, Italy

Received 21 March 2012; Accepted 7 May 2012

Academic Editors: J. Mansourati and J. M. Perez-Pomares

Copyright © 2012 Francesca Macaione et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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 = 1 2 1 ) consisting of patients receiving at discharge dual antiplatelet therapy (DAT) plus PPI and anti-H2 group ( 𝑛 = 5 5 ), consisting of patients receiving at discharge DAT + H2 receptor antagonist (H2RA). In a followup of 36 months the prevalence of ACS event ( 𝑃 = 0 . 0 1 4 ), TVR ( 𝑃 = 0 . 0 3 1 ) 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.