Key result
PPI use linked to ~3-fold higher CV event risk in aspirin-free patients.
Why the study?
Does proton pump inhibitor use affect cardiovascular events or major bleeding in patients undergoing PCI with an aspirin-free strategy?
Cohort
Does proton pump inhibitor use affect cardiovascular events or major bleeding in patients undergoing PCI with an aspirin-free strategy?
Absolute Event Rate: 7.1% vs 2.4%
p-value: p=0.002
In patients undergoing PCI with an aspirin-free P2Y12 inhibitor strategy, PPI use was associated with increased cardiovascular events and mortality without reducing major bleeding.
PPIs 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) CONCLUSIONS: PPI 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).
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Nishikura et al. (2025) conducted a cohort in Percutaneous Coronary Intervention. Proton Pump Inhibitors vs. No proton pump inhibitors was evaluated on Composite of cardiovascular death, myocardial infarction, definite stent thrombosis, or stroke (p=0.002). Proton pump inhibitor use was associated with a higher risk of cardiovascular events compared to no PPI use in patients on an aspirin-free strategy (7.1% vs 2.4%, P=0.002).
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