THE ASSOCIATION BETWEEN CONCOMITANT PROTON-PUMP INHIBITOR USE AND CLINICAL OUTCOMES IN PATIENTS WITH ACUTE CORONARY SYNDROMES TREATED WITH PRASUGREL VERSUS CLOPIDOGREL AND MANAGED WITHOUT REVASCULARIZATION: INSIGHTS FROM THE TRILOGY ACS STUDY

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dc.contributorSistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP
dc.contributor.authorNICOLAU, Jose C.
dc.contributor.authorBHATT, Deepak
dc.contributor.authorROE, Matthew
dc.contributor.authorNEELY, Benjamin
dc.contributor.authorCORBALAN, Ramon
dc.contributor.authorLEIVA-PONS, Jose
dc.contributor.authorMARTINEZ, Felipe
dc.contributor.authorGOODMAN, Shaun
dc.contributor.authorBROWN, Eileen
dc.contributor.authorVERHEUGT, Freek
dc.contributor.authorARMSTRONG, Paul
dc.contributor.authorWHITE, Harvey
dc.contributor.authorFOX, Keith
dc.contributor.authorPRABHAKARAN, Dorairaj
dc.contributor.authorOHMAN, E. Magnus
dc.date.accessioned2013-10-11T21:17:37Z
dc.date.available2013-10-11T21:17:37Z
dc.date.issued2013
dc.description.abstractBackground: There is conflicting evidence regarding the interaction among proton-pump inhibitors (PPIs), platelet P2Y12 inhibitors, and clinical outcomes in ACS patients. Methods: We evaluated 7243 ACS patients aged <75 y with UA/NSTEMI managed without revascularization enrolled in TRILOGY ACS, and analyzed the association between baseline PPI use and study treatment effect of prasugrel vs clopidogrel over 30 months. Adjusted hazard ratio (HR) estimates were derived using Cox proportional models weighted for inverse propensity of PPI use. Results: 1666 patients (23%) were taking a PPI at randomization. Those on PPIs at baseline were older, more likely to have NSTEMI and undergo angiography before randomization, and less likely to have prior heart failure (Table). Among those on PPI at baseline vs those not on PPI, there was no difference in adjusted risk of the primary efficacy endpoint of CV death, MI, or stroke with prasugrel (adjusted HR=1.11; 95% CI: 0.86–1.43), but there was a higher risk with PPI use with clopidogrel (adjusted HR=1.50; 95% CI: 1.19–1.89); interaction p=0.09. Conclusions: Patients with ACS managed medically and taking a PPI at baseline had a higher risk profile than those not on a PPI. Long-term risk of ischemic outcomes associated with PPI use was higher in those treated with clopidogrel vs those treated with prasugrel. Future analyses will evaluate this association with respect to the overall TRILOGY efficacy and safety results, including dedicated platelet function analyses.
dc.description.conferencedateMAR 09-11, 2013
dc.description.conferencelocalSan Francisco - CA, EUA
dc.description.conferencename62nd Annual Scientific Session of the American-College-of-Cardiology
dc.description.indexMEDLINE
dc.identifier.citationJOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, v.61, n.10, suppl.S, p.E39-E39, 2013
dc.identifier.issn0735-1097
dc.identifier.urihttps://observatorio.fm.usp.br/handle/OPI/2755
dc.language.isoeng
dc.publisherELSEVIER SCIENCE INC
dc.relation.ispartofJournal of the American College of Cardiology
dc.rightsrestrictedAccess
dc.rights.holderCopyright ELSEVIER SCIENCE INC
dc.subject.wosCardiac & Cardiovascular Systems
dc.titleTHE ASSOCIATION BETWEEN CONCOMITANT PROTON-PUMP INHIBITOR USE AND CLINICAL OUTCOMES IN PATIENTS WITH ACUTE CORONARY SYNDROMES TREATED WITH PRASUGREL VERSUS CLOPIDOGREL AND MANAGED WITHOUT REVASCULARIZATION: INSIGHTS FROM THE TRILOGY ACS STUDY
dc.typeconferenceObject
dc.type.categorymeeting abstract
dc.type.versionpublishedVersion
dspace.entity.typePublication
hcfmusp.contributor.author-fmusphcJOSE CARLOS NICOLAU
hcfmusp.description.beginpageE39
hcfmusp.description.endpageE39
hcfmusp.description.issue10
hcfmusp.description.issuesuppl S
hcfmusp.description.volume61
hcfmusp.origemWOS
hcfmusp.origem.wosWOS:000316555200040
hcfmusp.publisher.cityNEW YORK
hcfmusp.publisher.countryUSA
relation.isAuthorOfPublication2ff39bf2-b5fb-4568-a932-b466563074d8
relation.isAuthorOfPublication.latestForDiscovery2ff39bf2-b5fb-4568-a932-b466563074d8
Arquivos
Coleções
Comunicações em Eventos - FM/MCP
Comunicações em Eventos - HC/InCor
Comunicações em Eventos - LIM/11