New PPI use post-PCI was associated with higher GIB risk (HR 1.63; 95% CI 1.07-2.50), while persistent PPI use predicted increased mortality (HR 1.89; 95% CI 1.17-3.06) and hospitalization.
Cohort (n=3,734)
Yes
Does new or persistent proton pump inhibitor use affect mortality, MACE, gastrointestinal bleeding, or hospitalization in PPI-naïve patients undergoing first-time PCI?
More than half of patients initiating PPI therapy after PCI continue it beyond DAPT duration, which is associated with increased mortality and hospitalization without reducing bleeding rates.
Effect estimate: HR 1.63 (95% CI 1.07-2.50)
Absolute Event Rate: 8.9% vs 6.8%
Abstract Background Proton pump inhibitors (PPIs) following percutaneous coronary intervention (PCI) have been shown to reduce the risk of gastrointestinal bleeding (GIB) without influencing major adverse cardiovascular events (MACE). Current guidelines recommend PPIs for the duration of dual antiplatelet therapy (DAPT) in high-risk patients, but many may receive or continue them inappropriately. Purpose We explored the incidence and associated outcomes of new and persistent PPI use. Methods This retrospective cohort study included PPI-naïve individuals undergoing first-time PCI between 2010-2020 with 90 days of follow-up. Clinical data were derived from hospital registries. Medication data were derived from a central database containing all drug prescriptions in the country. New PPI use was defined as filling a prescription within 90 days from PCI. Persistent PPI use was defined for those still taking PPIs after a 1-year washout period following conventional DAPT cessation. Comparisons were made between those with and without new PPI use, as well as persistent and temporary PPI use. Cox regression was used to estimate the risk of all-cause mortality, MACE, GIB, and hospitalization up to 10 years following PCI. Logistic regression was used to identify variables associated with persistent PPI use. Propensity score matching (PSM) was used to generate covariate balance. Results Out of 6726 individuals, 3734 (55.5%) were PPI-naïve and met other inclusion criteria. New PPI users were 804 (21.5%), out of which 417 (51.9%) developed persistent PPI use. Before PSM, new PPI users were significantly older, had higher comorbidity burden and frailty risk. After PSM, new PPI use was associated with a higher risk of GIB (absolute risk: 8.9% vs 6.8%, HR: 1.63, CI: 1.07-2.50), driven by GIB within the first year from PCI, but was not associated with mortality (HR: 1.08, CI: 0.86-1.37), MACE (HR: 0.91 CI: 0.75-1.11) or hospitalization (HR: 1.22, CI: 0.96-1.56). A landmark analysis at 2 years comparing temporary and persistent PPI users showed an increased risk of mortality (HR: 1.89, CI: 1.17-3.06) and hospitalization (HR: 1.53, CI: 1.11-2.14) in persistent users, with no effect on early or late GIB. Conclusions More than half of patients initiating PPI therapy following PCI continue the medication beyond the duration of DAPT. New PPI use was paradoxically associated with an increased risk of GIB, possibly reflecting a higher baseline risk at the time of prescribing. However, persistent PPI use predicted an increased risk of hospitalization and mortality without significantly reducing bleeding rates. The appropriateness of continued PPI therapy should be assessed in patients following cessation of antithrombotic therapy, as it may contribute to unnecessary polypharmacy in a frailer population.Trends of PPI use following PCI Persistent vs. Temporary PPI outcomes
Heitmann et al. (Sat,) conducted a cohort in First-time percutaneous coronary intervention (PCI) (n=3,734). Proton pump inhibitors (PPIs) vs. No new PPI use / temporary PPI use was evaluated on Gastrointestinal bleeding (GIB) (HR 1.63, 95% CI 1.07-2.50). New PPI use post-PCI was associated with higher GIB risk (HR 1.63; 95% CI 1.07-2.50), while persistent PPI use predicted increased mortality (HR 1.89; 95% CI 1.17-3.06) and hospitalization.