Abstract | BACKGROUND: METHODS AND RESULTS: Using data on 11 955 acute myocardial infarction (MI) patients treated with percutaneous coronary intervention at 233 hospitals and enrolled in the TRANSLATE-ACS study, we compared whether discharge PPI use altered the association of 1-year adjusted risks of major adverse cardiovascular events ( MACE; death, MI, stroke, or unplanned revascularization) and Global Use of Strategies To Open Occluded Arteries (GUSTO) moderate/severe bleeding between prasugrel- and clopidogrel-treated patients. Overall, 17% of prasugrel-treated and 19% of clopidogrel-treated patients received a PPI at hospital discharge. At 1 year, patients discharged on a PPI versus no PPI had higher risks of MACE (adjusted hazard ratio [HR] 1.38, 95% confidence interval [CI] 1.21-1.58) and GUSTO moderate/severe bleeding (adjusted HR 1.55, 95% CI 1.15-2.09). Risk of MACE was similar between prasugrel and clopidogrel regardless of PPI use (adjusted HR 0.88, 95% CI 0.62-1.26 with PPI, adjusted HR 1.07, 95% CI 0.90-1.28 without PPI, interaction P=0.31). Comparative bleeding risk associated with prasugrel versus clopidogrel use differed based on PPI use but did not reach statistical significance (adjusted HR 0.73, 95% CI 0.36-1.48 with PPI, adjusted HR 1.34, 95% CI 0.79-2.27 without PPI, interaction P=0.17). CONCLUSIONS: CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01088503.
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Authors | Larry R Jackson 2nd, Eric D Peterson, Lisa A McCoy, Christine Ju, Marjorie Zettler, Brian A Baker, John C Messenger, Douglas E Faries, Mark B Effron, David J Cohen, Tracy Y Wang |
Journal | Journal of the American Heart Association
(J Am Heart Assoc)
Vol. 5
Issue 10
(10 21 2016)
ISSN: 2047-9980 [Electronic] England |
PMID | 27792656
(Publication Type: Comparative Study, Journal Article)
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Copyright | © 2016 The Authors and Eli Lilly & Company. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell. |
Chemical References |
- Platelet Aggregation Inhibitors
- Proton Pump Inhibitors
- Purinergic P2Y Receptor Antagonists
- Clopidogrel
- Prasugrel Hydrochloride
- Ticlopidine
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Topics |
- Acute Coronary Syndrome
(drug therapy, surgery)
- Aftercare
- Aged
- Cardiovascular Diseases
(mortality)
- Clopidogrel
- Comparative Effectiveness Research
- Female
- Gastrointestinal Hemorrhage
(chemically induced, epidemiology)
- Hemorrhage
(chemically induced, epidemiology)
- Humans
- Longitudinal Studies
- Male
- Middle Aged
- Myocardial Infarction
(drug therapy, surgery)
- Myocardial Revascularization
(statistics & numerical data)
- Percutaneous Coronary Intervention
- Platelet Aggregation Inhibitors
(therapeutic use)
- Prasugrel Hydrochloride
(therapeutic use)
- Proportional Hazards Models
- Proton Pump Inhibitors
(therapeutic use)
- Purinergic P2Y Receptor Antagonists
(therapeutic use)
- Recurrence
- Stroke
(epidemiology)
- Ticlopidine
(analogs & derivatives, therapeutic use)
- Treatment Outcome
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