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Proton Pump Inhibitor Use, Gastrointestinal Bleeding Reduction, and Long-Term Prognosis After Percutaneous Coronary
Tatsuya Tokai1, Masanobu Ishii2, Yasuhiro Otsuka3
1Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan; Department of Cardiovascular Medicine, Miyazaki Prefectural Nobeoka Hospital, Miyazaki, Japan.
Insights
Proton pump inhibitors (PPIs) reduce gastrointestinal bleeding (GIB) after percutaneous coronary intervention (PCI). In acute coronary syndrome (ACS) patients, PPIs may lower mortality and major adverse cardiovascular events (MACE), partly due to GIB reduction.
Area of Science:
- Cardiology
- Gastroenterology
- Pharmacology
Background:
- Proton pump inhibitors (PPIs) are used to reduce gastrointestinal bleeding (GIB) risk in patients undergoing percutaneous coronary intervention (PCI).
- The impact of PPIs on mortality and major adverse cardiovascular events (MACE) following PCI requires further investigation.
Purpose of the Study:
- To investigate the association between PPI use, GIB reduction, and outcomes like MACE and mortality after PCI.
- To explore the potential mediating role of GIB reduction in the relationship between PPI use and mortality.
Main Methods:
- Analysis of a real-world database of 6,457 patients undergoing PCI between 2013 and 2019.
- Utilized propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) for comparative analysis.
- Employed Cox regression and mediation analysis to assess hazard ratios and causal inference.
Main Results:
- PPI use was associated with significantly lower GIB incidence compared to non-PPI users.
- No significant association between PPI use and overall mortality or MACE was observed in the general PCI population.
- In patients with acute coronary syndrome (ACS), PPI use was linked to reduced all-cause death and MACE (IPTW analysis).
Conclusions:
- PPIs effectively reduce GIB risk post-PCI.
- In ACS patients, PPI use may improve survival and reduce MACE, with GIB reduction acting as a partial mediator.
- Findings suggest a potential benefit of PPIs in specific high-risk patient subgroups undergoing PCI.
Abstract:
Proton pump inhibitors (PPI) reduce gastrointestinal bleeding (GIB) after percutaneous coronary intervention (PCI), but their impact on mortality and major adverse cardiovascular events (MACE) remains unclear. This study investigated the association between PPI-related GIB reduction and MACE and mortality using a real-world database. We analyzed 6,457 patients undergoing PCI (2013 to 2019), using the Clinical Deep Data Accumulation System including electronic medical records from 7 Japanese hospitals. Patients were grouped by PPI use. The primary outcome was GIB and secondary outcomes were all-cause mortality and MACE. Propensity score matching (PSM), inverse probability of treatment weighting (IPTW), and Cox regression were used to estimate hazard ratios. To estimate causal inference, mediation analysis was conducted to assess the indirect effects of PPI use via GIB reduction. PSM and IPTW analyses revealed a lower GIB incidence in the PPI group (PSM: <0.1%, IPTW: 1.6%) than in the non-PPI group (PSM: 2.3%, IPTW: 2.7%). No significant association was found between PPI use and all-cause death or MACE. However, in patients with acute coronary syndrome (ACS), IPTW analysis indicated that PPI use was associated with lower all-cause death (HR: 0.582, 95% CI: 0.364 to 0.931) and MACE (HR: 0.570, 95% CI: 0.344 to 0.946). Importantly, mediation analysis suggested that GIB reduction partially mediated the association between PPI use and lower mortality. In conclusion, PPI use after PCI was associated with lower GIB risk. In ACS patients, it may be associated with a reduction in all-cause mortality, partially mediated by GIB reduction.
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