Key result
Adding PPIs to antiplatelet therapy in ACS is linked to ~77% higher mortality.
Why the study?
Studies have reported that PPIs can alter the pharmacokinetics of antiplatelet agents and result in adverse cardiovascular events when used together to prevent gastrointestinal hemorrhage in acute coronary syndrome.
Does concomitant use of antiplatelet agents and proton-pump inhibitors increase the risk of all-cause mortality, myocardial infarction, and coronary revascularization in patients with acute coronary syndrome?
Cohort (n=1,555)
Does concomitant use of antiplatelet agents and proton-pump inhibitors increase the risk of all-cause mortality, myocardial infarction, and coronary revascularization in patients with acute coronary syndrome?
In patients with acute coronary syndrome, the concomitant use of antiplatelet agents and proton-pump inhibitors is associated with a significantly increased risk of mortality, myocardial infarction, and coronary revascularization compared to antiplatelet therapy alone.
Answers are grounded in this paper and cite their sources.
May warrant caution with concomitant PPI-antiplatelet use in ACS; leaves open confounding versus interaction pending randomized data.
Antiplatelet agents are commonly used in combination with proton-pump inhibitors (PPIs) in patients with acute coronary syndrome who are at risk of gastrointestinal hemorrhage. However, studies have reported that PPIs can alter the pharmacokinetics of antiplatelet agents and result in adverse cardiovascular events. We enrolled 311 patients who received antiplatelet therapy with PPIs for >30 days and 1244 matched controls following a 1:4 propensity score matching during the index period. Patients were followed up until death, myocardial infarction, coronary revascularization, or the end of the follow-up period. Patients who used antiplatelet therapy with PPIs were found to be at higher risk of mortality than the controls (adjusted hazard ratio (HR): 1.77; 95% confidence interval (CI): 1.30-2.40). The adjusted HR for patients who used antiplatelet agents with PPIs developing myocardial infarction and coronary revascularization events was 3.52 (95% CI: 1.34-9.22) and 4.74 (95% CI: 2.03-11.05), respectively. Additionally, middle-aged patients or those within 3 years of concomitant use showed a higher risk of myocardial infarction and coronary revascularization. Our findings suggest that antiplatelet therapy combined with PPIs has a higher mortality risk in patients with gastrointestinal bleeding and is associated with an increased risk of myocardial infarction and coronary revascularization.
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Yang et al. (2023) conducted a cohort in Acute coronary syndrome (n=1,555). Concomitant antiplatelet agents and proton-pump inhibitors vs. Antiplatelet agents without proton-pump inhibitors was evaluated on All-cause mortality (HR 1.77, 95% CI 1.30-2.40). Concomitant use of antiplatelet agents and proton-pump inhibitors in patients with acute coronary syndrome was associated with a 77% increased risk of mortality (HR 1.77) compared to antiplatelet therapy alone.
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