Effect of Proton Pump Inhibitors in Patients Undergoing Percutaneous Coronary Intervention With Aspirin-Free Strategy

Safety of proton pump inhibitors (PPIs) in patients undergoing percutaneous coronary intervention (PCI) with aspirin-free P2Y₁₂ inhibitor monotherapy was unknown.

The authors aimed to evaluate effects of PPIs in patients undergoing PCI with P2Y₁₂ inhibitor monotherapy.

We compared outcomes between patients with and without PPI prescription in the STOPDAPT-3 trial enrolling patients undergoing PCI stratified by the no-aspirin (1-month prasugrel monotherapy followed by clopidogrel monotherapy: n = 2,909 [acute coronary syndrome: n = 2,170, high bleeding risk: n = 1,580]) and the aspirin (1-month dual antiplatelet therapy followed by aspirin monotherapy: n = 2,914 [acute coronary syndrome: n = 2,171, high bleeding risk: n = 1,566]) strategies at 1 year.

PPIs were prescribed in 2,418 patients (83.1%) with the no-aspirin strategy, and in 2,695 patients (92.5%) with the aspirin strategy. In the propensity score matched cohort (no-aspirin strategy: n = 902 and aspirin strategy: n = 376), a composite of cardiovascular death, myocardial infarction, definite stent thrombosis, or stroke more often occurred in the PPI group than in the no-PPI group with the no-aspirin strategy (7.1% vs 2.4%, P = 0.002), but not with the aspirin strategy (6.9% vs 7.4%, P = 0.817). Death also more often occurred in the PPI group than in the no-PPI group with the no-aspirin strategy, but not with the aspirin strategy. Incidence of major bleeding was not different between the groups regardless of the no-aspirin and aspirin strategies (5.5% vs 3.3%, P = 0.150, and 6.9% vs 4.3%, P = 0.278) CONCLUSIONS: PPI use was associated with higher risks of cardiovascular events and mortality without decreasing major bleeding in patients undergoing PCI with aspirin-free P2Y₁₂ inhibitor monotherapy. (ShorT and OPtimal duration of Dual AntiPlatelet Therapy after everolimus-eluting cobalt-chromium stent-3 [STOPDAPT-3]; NCT04609111).