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Long-Term Effects of Proton Pump Inhibitors in Patients Undergoing Percutaneous Coronary Intervention in High-Risk
Ko Yamamoto1, Erika Yamamoto2, Takeshi Morimoto3
1Department of Cardiology, Kokura Memorial Hospital.
Insights
Proton pump inhibitors (PPIs) reduce upper gastrointestinal bleeding (UGIB) risk in patients undergoing percutaneous coronary intervention (PCI). These benefits persist across various high-risk patient subgroups, though PPIs did not increase ischemic event risk.
Area of Science:
- Cardiology
- Gastroenterology
- Pharmacology
Background:
- Proton pump inhibitors (PPIs) are commonly used in patients undergoing percutaneous coronary intervention (PCI).
- Previous studies suggest PPIs may reduce upper gastrointestinal bleeding (UGIB) risk in this population.
- The differential impact of PPIs in high-risk subgroups undergoing PCI remains unclear.
Purpose of the Study:
- To evaluate the long-term effects of PPIs on UGIB in patients undergoing PCI.
- To investigate whether PPI benefits vary across defined high-risk subgroups.
Main Methods:
- Analysis of 24,563 patients from the CREDO-Kyoto registry (Cohorts 2 and 3) undergoing their first PCI.
- Assessment of PPI use and its association with UGIB (GUSTO moderate/severe bleeding) over a median 5.6-year follow-up.
- Subgroup analyses were performed based on age, sex, acute coronary syndrome, high bleeding risk, oral anticoagulant use, and P2Y12 inhibitor type.
Main Results:
- 45.6% of patients received PPIs.
- PPIs were associated with a significantly lower adjusted risk of UGIB (HR 0.64; P<0.001).
- No significant association was found between PPIs and GUSTO moderate/severe bleeding (HR 1.04; P=0.40), myocardial infarction/ischemic stroke (HR 1.00; P=0.97), but a higher adjusted mortality risk (HR 1.18; P<0.001).
- The effects of PPIs on UGIB, ischemic events, and mortality were consistent across all evaluated high-risk subgroups.
Conclusions:
- PPIs are associated with a reduced risk of UGIB in patients undergoing PCI.
- The protective effect of PPIs against UGIB is consistent across various high-risk subgroups.
- PPIs demonstrated a neutral risk for ischemic events but were associated with increased mortality in this cohort.
Background:
Proton pump inhibitors (PPIs) reportedly reduce upper gastrointestinal bleeding (UGIB) in patients undergoing percutaneous coronary intervention (PCI). However, whether the benefits of PPIs differ in high-risk subgroups is unknown.
Methods And Results:
Among 24,563 patients undergoing first PCI in the CREDO-Kyoto registry Cohort-2 and -3, we evaluated long-term effects of PPI for UGIB, defined as GUSTO moderate/severe bleeding, in several potential high-risk subgroups. In the study population, 45.6% of patients were prescribed PPIs. Over a median 5.6-year follow-up, PPIs were associated with lower adjusted risk of UGIB (hazard ratio [HR] 0.64; 95% confidence interval [CI] 0.50-0.80; P<0.001) and a non-significant but numerically lower risk of any gastrointestinal bleeding (HR 0.84; 95% CI 0.71-1.01; P=0.06). PPIs were not associated with a lower risk of GUSTO moderate/severe bleeding (HR 1.04; 95% CI 0.94-1.15; P=0.40) or a higher adjusted risk of myocardial infarction or ischemic stroke (HR 1.00; 95% CI 0.90-1.12; P=0.97), but were associated with higher adjusted mortality risk (HR 1.18; 95% CI 1.09-1.27; P<0.001). The effects of PPIs for UGIB, myocardial infarction or ischemic stroke, and all-cause death were consistent regardless of age, sex, acute coronary syndrome, high bleeding risk, oral anticoagulant use, and type of P2Y12inhibitor.
Conclusions:
PPIs were associated with a lower risk of UGIB and a neutral risk of ischemic events regardless of high-risk subgroup.
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