Effects of proton pump inhibitors on gastrointestinal bleeding and cardiovascular outcomes in myocardial infarction patients treated with dual antiplatelet therapy (DAPT)
Main finding · Major gastrointestinal bleeding requiring transfusion with hospitalisation (primary efficacy endpoint)Result — go to the resultHazard ratio 0.59 95% CI 0.48–0.73Authors' conclusion
In real-world data from a large study of East Asian patients with AMI undergoing PCI and maintaining DAPT, PPI use significantly reduced the risk of major gastrointestinal bleeding without increasing ischaemic events, irrespective of bleeding risk or type of P2Y12 inhibitor. (ClinicalTrials.gov: NCT06241833).
Study context
- Population
- Patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI) with dual antiplatelet therapy (DAPT), East Asian (Korean)pairs after propensity score (PS) matching, 30.0% of patients (n=35,566) received proton pump inhibitors (PPIs) with DAPT before matching
- Participants
- 35,560 patients
- Exposure
- Co-prescription of PPIs and DAPT vs DAPT without PPIs
- Outcome
- Major gastrointestinal bleeding requiring transfusion with hospitalisation (primary efficacy endpoint)
- Follow-up
- 1 year
Methodological detailslarge-scale propensity score (PS) matching, real-world data
- Large-scale propensity score (PS) matching
- Real-world data
Main finding
As reported in the abstract
Hazard ratio
0.59
95% CI 0.48–0.73
By group
PPIsvs without PPIs
HR 0.59 (95% CI 0.48–0.73)
Observational data: associations, not effects.
Further findings
Subgroups by P2Y12 inhibitor type, PPI type, individual bleeding risk
- Beneficial effects of PPIs on gastrointestinal bleeding, without increased risk of cardiovascular events, observed consistently
Safety
| Outcome | PPIs | Without PPIs | HR (95% CI) | |
|---|---|---|---|---|
| MACCE (cardiovascular death, spontaneous myocardial infarction, repeat revascularisation, ischaemic stroke) (primary safety endpoint) · 1 yearDid not differ significantly | 13.4% | 13.1% | 0.98 (0.94–1.02) | |
| 0.512Hazard ratio (log scale) |
Original publication
Effects of proton pump inhibitors on gastrointestinal bleeding and cardiovascular outcomes in myocardial infarction patients treated with DAPT. EuroIntervention. Published 17 February 2025. doi:10.
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