Journal Article

Adverse cardiovascular outcomes associated with proton pump inhibitor use after percutaneous coronary intervention: a systematic review and meta-analysis

Rustagi, Sarvesh, Satapathy, Prakasini, Padhi, Bijaya K., Zahiruddin, Quazi Syed, Rao, Arathi P., Sharma, Rakesh Kumar, Khatib, Mahalaqua Nazli, Sah, Ranjit

2024

Overview

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.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Aged / Angiology / Angioplasty / Antiplatelet therapy / Blood Transfusion Medicine / Cardiac Surgery / Cardiology / Cardiovascular disease / Cardiovascular diseases / Cardiovascular Diseases - diagnosis / Cardiovascular Diseases - epidemiology / Cardiovascular Diseases - prevention & control / Care and treatment / Clinical trials / Clopidogrel / Cohort analysis / Complications and side effects / Coronary artery disease / Coronary vessels / Diabetes / Dosage and administration / Female / Gastrointestinal Hemorrhage - chemically induced / Gastrointestinal Hemorrhage - epidemiology / Heart attack / Heart attacks / Heart diseases / Humans / Hypertension / Internal Medicine / Intervention / Male / Medical research / Medicine / Medicine & Public Health / Medicine, Experimental / Meta-analysis / Middle Aged / Mortality / Myocardial infarction / Observational studies / Observational Studies as Topic / Pantoprazole / Patient outcomes / Percutaneous coronary intervention / Percutaneous Coronary Intervention - adverse effects / Population studies / Proton pump inhibitors / Proton Pump Inhibitors - adverse effects / Proton Pump Inhibitors - therapeutic use / Protons / Risk Assessment / Risk Factors / Software / Systematic Review / Ticagrelor / Time Factors / Transluminal angioplasty / Treatment Outcome / Vein & artery diseases