Key result
Spanish center management linked to ~150% higher odds of discharge PPIs in high-risk PCI patients.
Why the study?
Does the rate of appropriate proton pump inhibitor (PPI) prescription for gastroprotection in high-risk PCI patients on dual antiplatelet therapy differ between a Spanish and a US cardiology center?
Cross-Sectional (n=429)
Yes
Does the rate of appropriate proton pump inhibitor (PPI) prescription for gastroprotection in high-risk PCI patients on dual antiplatelet therapy differ between a Spanish and a US cardiology center?
Odds Ratio: 2.5 (95% CI 1.3–4.7)
Absolute Event Rate: 75.4% vs 55.6%
There is significant underutilization of gastroprotective PPI therapy in high-risk PCI patients on dual antiplatelet therapy, with notable differences in prescription rates and risk stratification between US and Spanish centers.
Center variation in post-PCI PPI prescribing should not change practice; leaves open drivers of regional differences and need for prospective standardization studies.
BACKGROUND: Proton pump inhibitors (PPIs) are the preferred agents for the prevention of aspirin-associated upper gastrointestinal bleeding (UGIB). Data are limited to determine whether PPIs are being used to reduce UGIB risk. AIM: To evaluate the implementation of PPI treatment to reduce the GI risk in two cardiology centres from Europe and the United States. METHODS: A retrospective cross-sectional study was carried out at the University of Michigan and University Hospital-Zaragoza in 429 consecutive patients hospitalized for percutaneous coronary intervention (PCI) on dual antiplatelet therapy. RESULTS: Admission for PPI co-therapy was similar (34% vs. 30%) in both centres. At discharge, the proportion of high-risk patients receiving PPI therapy in the Spanish centre (75.4%) was higher than their American peers (55.6%) (OR: 2.5; 95% CI; 1.3-4.7). No differences in PPI prescription rates were found among Spanish patients with/without GI risk factors. The opportunity to initiate PPI co-therapy in high-risk patients was missed in 81.8% (36/44) of those not on PPI at admission in US patients vs. 24.1% (19/79) (P < 0.0001) in Spanish patients. CONCLUSIONS: There are important differences concerning PPI prescription and risk stratification in the two centres when managing PCI patients. Efforts to stratify risks and utilize appropriate strategies for UGIB prophylaxis in high-risk patients are warranted.
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Casado-Arroyo et al. (2010) conducted a cross-sectional in Percutaneous coronary intervention (PCI) on dual antiplatelet therapy (n=429). Management at Spanish cardiology center vs. Management at US cardiology center was evaluated on Proportion of high-risk patients receiving PPI therapy at discharge (OR 2.5, 95% CI 1.3-4.7). High-risk PCI patients managed at the Spanish center were more likely to receive PPI therapy at discharge compared to those at the US center (75.4% vs 55.6%; OR 2.5, 95% CI 1.3-4.7).
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