ADAPT-DES: PPI increased high platelet reactivity in DES setting

Concomitant administration of proton pump inhibitors and dual antiplatelet therapy yielded increased rates of high platelet reactivity in patients undergoing PCI with drug-eluting stents, according to results from the ADEPT-DES registry.

The researchers evaluated data from 8,582 patients who underwent coronary intervention at 11 sites throughout the United States and Germany. The cohort included 2,697 patients who were on proton pump inhibitors (PPI) at the time of intervention, and 2,162 who received a prescription for a PPI upon discharge from the hospital. All patients were treated with antiplatelet therapy, including 1 year or more of clopidogrel and aspirin for an indefinite period after PCI.

Giora Weisz, MD, from the Shaare Zedek Medical Center in Jerusalem, and researchers used the VerifyNow assay (Accriva Diagnostics) to assess on-treatment P2Y12 platelet reactivity after a loading dose of clopidogrel and successful DES implantation, with follow-up of 2 years. The primary endpoint was definite or probable stent thrombosis, with other evaluated endpoints including all-cause mortality, MI and clinically relevant bleeding.

Patients had high platelet reactivity, defined as more than 208 P2Y12 reactivity units, in 48.5% of cases in the PPI group and 40.8% of those who did not receive PPI (P < .0001). Results from adjusted analyses indicated an independent association between PPI use and high platelet reactivity (OR = 1.38; 95% CI, 1.25-1.52).

No significant association was observed between PPI use and increased risk for stent thrombosis, either in-hospital or at 2 years post-discharge. Results from propensity-matched multivariate analysis at 2-year follow-up indicated an independent association between PPI use and increased risk for MACE, defined as cardiac death, MI, or ischemia-driven target lesion revascularization, (HR = 1.21; 95% CI, 1.04-1.42).

The researchers also observed a borderline significant association between PPI use and clinically driven target vessel revascularization (HR = 1.27; 95% CI, 1.09-1.49), along with a strong trend toward increased mortality risk in the PPI group (HR = 1.28; 95% CI, 1-1.63). However, 2-year clinically relevant bleeding outside the hospital setting was not increased in the PPI group (HR = 1.03; 95% CI, 0.84-1.26).

“In patients treated with aspirin and clopidogrel after successful DES implantation in the large-scale, prospective ADAPT-DES study, the concomitant administration of a PPI was associated with [high platelet reactivity] and an increased rate of MACE occurring during 2-year follow-up,” the researchers concluded. – by Rob Volansky

Disclosure: Weisz reports serving on advisory boards for AngioSlide, AstraZeneca, Calore, Corindus, Medivizer and Medtronic. Please see the full study for a list of all other authors’ relevant financial disclosures.

Source: www.healio.com