Key result
While observational studies suggested proton pump inhibitor use after percutaneous coronary intervention was associated with an increased risk of cardiovascular diseases (HR 1.20), randomized controlled trials showed no significant association (RR 1.016).
Why the study?
Proton pump inhibitors are commonly prescribed post-PCI for gastroprotection during antiplatelet therapy, but emerging evidence suggests they may adversely impact cardiovascular outcomes.
Does proton pump inhibitor use increase adverse cardiovascular outcomes in patients following percutaneous coronary intervention?
Meta-Analysis
Yes
Does proton pump inhibitor use increase adverse cardiovascular outcomes in patients following percutaneous coronary intervention?
Hazard Ratio: 1.2 (95% CI 1.093–1.308)
While observational studies suggest an association between PPI use and adverse cardiovascular events post-PCI, meta-analysis of RCTs does not support this risk, highlighting the need to balance gastroprotective benefits against potential but unproven cardiovascular risks.
BACKGROUND: Proton pump inhibitors (PPIs) are commonly prescribed for gastroprotection in patients undergoing percutaneous coronary intervention (PCI), who are at increased risk of gastrointestinal bleeding due to antiplatelet therapy. However, emerging evidence suggests that PPIs may adversely impact cardiovascular outcomes. This systematic review and meta-analysis sought to assess the relationship between using PPIs and cardiovascular outcomes in patients following PCI. METHODS: We searched various databases up to March 15, 2024, for observational studies and randomized controlled trials (RCTs) assessing the cardiovascular effects of PPIs in PCI patients. Data were extracted on study characteristics, patient demographics, PPI use, and cardiovascular outcomes. The Newcastle-Ottawa Scale and Cochrane Risk of Bias Tool 2 assessed study quality. Meta-analyses were conducted using a random-effects model using R software version 4.3. RESULTS: A total of 21 studies involving diverse populations and study designs were included. Observational studies suggested a moderate increase in risk for composite cardiovascular diseases (CVD), myocardial infarction (MI), and major adverse cardiac events (MACE) associated with PPI use, with pooled hazard ratios (HRs) of 1.20 (95% CI: 1.093-1.308) for CVD, 1.186 (95% CI: 1.069-1.303) for MI, and 1.155 (95% CI: 1.001-1.309) for MACE. However, RCTs showed no significant link between PPI therapy and negative cardiovascular events (Relative Risk: 1.016, 95% CI: 0.878-1.175). Substantial heterogeneity was observed among observational studies but not RCTs. CONCLUSION: The findings indicate that while observational studies suggest a potential risk of adverse cardiovascular events with post-PCI use of PPI, RCTs do not support this association. Further large-scale, high-quality studies are required to understand the cardiovascular implications of individual PPIs better and optimize patient management post-PCI. This analysis shows the complexity of PPI use in patients with coronary artery diseases and the necessity to balance gastroprotective benefits against potential cardiovascular risks.
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Padhi et al. (2024) conducted a meta-analysis in Patients undergoing percutaneous coronary intervention (PCI). Proton pump inhibitors (PPIs) vs. Non-PPI users or placebo was evaluated on Composite cardiovascular diseases (CVD) in observational studies (HR 1.20, 95% CI 1.093-1.308). While observational studies suggested proton pump inhibitor use after percutaneous coronary intervention was associated with an increased risk of cardiovascular diseases (HR 1.20), randomized controlled trials showed no significant association (RR 1.016).
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