Influence of the Concomitant Use of Clopidogrel and Proton Pump Inhibitors on Adverse Cardiovascular Events in Korean Patients with Acute Coronary Syndrome

초록

Purpose: Recent investigations suggest that the antiplatelet effect of clopidogrel may be decreased when thismedication is taken together with certain proton pump inhibitors (PPIs). However, there has been no studyconducted in Korea regarding the clinical effect of clopidogrel-PPI interaction. This study targeted patientswho received stents to investigate the effect of the concomitant use of clopidogrel and PPIs on the occurrenceof adverse cardiovascular events in Korean patients. Methods: The patients who received a stentinsertion at the Yeouido St. Mary’s Hospital between January 2010 and April 2011 were included. Thepatients were divided into two groups, clopidogrel and clopidogrel + PPI, and followed for 12 months afterthe date of stent insertion using prescription history and medical records. The recurrence rates of the cardiovascularevents among the two patient groups were statistically analyzed. Results: There was no differencebetween the two groups in the basic characteristics of the 157 patients in the clopidogrel group andthe 62 patients in the clopidogrel + PPI group. Simple logistic regression showed a significantly higher rateof re-hospitalization in the clopidogrel + PPI group (OR=1.893, 95% CI 1.040-3.445, p=0.037). However, theresults of the multivariate logistic regression of the variables found to have statistical significance bycrosstabulation showed no significant difference in the rate of adverse cardiovascular events or re-hospitalizationbetween the two groups. Conclusions: There was no significant difference between the clopidogrel andclopidogrel+PPI group among new patients with cardiovascular stents with respect to the occurrence ofrevascularization procedures, stent thrombosis, or chest pain, or with respect to the re-hospitalization rate forall cardiovascular events.

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