Source: DGNews  |  Posted 2 years ago

By Deborah Brauser

ORLANDO, Fla -- November 30, 2009 -- Proton pump inhibitors (PPIs) are
associated with an increased risk of all-cause mortality after patients undergo
percutaneous coronary intervention (PCI) with drug-eluting stents (DES),
according to a study presented here at the American Heart Association (AHA)
Scientific Sessions 2009.

In addition, the multivariable adjusted risk of mortality among patients taking
omeprazole was 72% higher and 54% higher for those taking pantoprazole when
compared with patients not taking any PPIs.

“We wanted to know: are PPIs safe or not safe?” said lead investigator Joseph
Sweeny, MD, Mount Sinai Medical Center, New York, New York, during his podium
presentation on November 16. “And if not, which ones are not safe? And what is
the risk of mortality associated with PPI use?”

For the study, Dr. Sweeny and colleagues evaluated 8,311 consecutive patients
who had PCI with DES between April 2003 and June 2007, with follow-up through
mid-2008. A total of 17% of the patients were taking PPIs, which included
esomeprazole (n = 312), lansoprazole (n = 469), omeprazole (n = 193),
pantoprazole (n = 374), and others (n = 37).

The primary outcome was death from all causes, while 30-day stent thrombosis
and lesion revascularisation after PCI were secondary.

At a median follow-up of 2.1 years, investigators found that 602 patients died,
with death rates significantly higher for those taking PPIs compared with those
not taking the drugs (53.5 vs 33.0 deaths per 1,000 person-years, respectively;
P < .001). In addition, the hazard ratio was 1.53 for those taking
PPIs vs those who did not and the overall multivariate adjusted hazard ratio
was 1.37.

“This hazard ratio, or the increased mortality, was consistent among all
subgroup analysis,” reported Dr. Sweeny.

When comparing the specific PPIs, higher adjusted hazard ratios were found in
patients taking omeprazole (1.72) or pantoprazole (1.54) versus those taking
lansoprazole or esomeprazole (1.02 and 0.97, respectively). Neither
lansoprazole nor esomeprazole-treated patients showed a significantly increased
risk of death when compared with patients not taking PPIs.

Finally, there were 759 target lesion revascularisations and 14 cases of stent
thrombosis, but neither was statistically significantly associated with PPI use.

“Overall, in this patient population, use of PPIs was associated with an
increased risk of all-cause mortality and the high risk appears to be limited
to omeprazole and pantoprazole,” concluded Dr. Sweeny. “In my opinion, the
findings were not unexpected given the profiles of the treatments involved.”

Presentation title: Mortality Associated With Proton Pump Inhibitors
Following Percutaneous Coronary Interventions With Drug Eluting Stents.
Abstract 4323