Tenjin Nishikura, Ko Yamamoto, Kohei Wakabayashi, Masahiro Natsuaki, Hirotoshi Watanabe, Takeshi Morimoto, Yuki Obayashi, Ryusuke Nishikawa, Tomoya Kimura, Tomoya Kimura, Kenji Andò, Satoru Suwa, Tsuyoshi Isawa, Hiroyuki Takenaka, Tetsuya Ishikawa, Y Onishi, Kiyoshi Hibi, Kazuya Kawai, Tsutomu Murakami, Akihiro Takasaki, Nobuya Higashitani, Masataka Nakano, Koh Ono, Takeshi Kimura, Takeshi Kimura
BackgroundSafety of proton pump inhibitors (PPIs) in patients undergoing percutaneous coronary intervention (PCI) with aspirin-free P2Y12 inhibitor monotherapy was unknown. ObjectivesThe authors aimed to evaluate effects of PPIs in patients undergoing PCI with P2Y12 inhibitor monotherapy. MethodsWe 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. ResultsPPIs 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) ConclusionsPPI 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)