Use of Proton-Pump Inhibitors Predicts Heart Failure and Death in Patients with Coronary Artery Disease.

Proton-pump inhibitors (PPIs) seem to increase the incidence of cardiovascular events in patients with coronary artery disease (CAD), mainly in those using clopidogrel. We analysed the impact of PPIs on the prognosis of patients with stable CAD.We followed 706 patients with CAD. Primary outcome was the combination of secondary outcomes. Secondary outcomes were 1) acute ischaemic events (any acute coronary syndrome, stroke, or transient ischaemic attack) and 2) heart failure (HF) or death.Patients on PPIs were older [62.0 (53.0-73.0) vs. 58.0 (50.0-70.0) years; p = 0.003] and had a more frequent history of stroke (4.9% vs. 1.1%; p = 0.004) than those from the non-PPI group, and presented no differences in any other clinical variable, including cardiovascular risk factors, ejection fraction, and therapy with aspirin and clopidogrel. Follow-up was 2.2±0.99 years. Seventy-eight patients met the primary outcome, 53 developed acute ischaemic events, and 33 HF or death. PPI use was an independent predictor of the primary outcome [hazard ratio (HR) = 2.281 (1.244-4.183); p = 0.008], along with hypertension, body-mass index, glomerular filtration rate, atrial fibrillation, and nitrate use. PPI use was also an independent predictor of HF/death [HR = 5.713 (1.628-20.043); p = 0.007], but not of acute ischaemic events. A propensity score showed similar results.In patients with CAD, PPI use is independently associated with an increased incidence of HF and death but not with a high rate of acute ischaemic events. Further studies are needed to confirm these findings

Characteristics of patients with and without treatment with proton-pump inhibitors.

<p>Characteristics of patients with and without treatment with proton-pump inhibitors.</p

Kaplan-Meier curves showing time to the outcomes in patients with or without PPIs.

<p>(A) Time to primary outcome (acute ischaemic events, heart failure or death). (B) Time to heart failure or death. (C) Time to acute ischaemic events.</p

Cox proportional hazards model for the incidence of primary outcome: acute ischaemic events, heart failure, or death.

<p>Cox proportional hazards model for the incidence of primary outcome: acute ischaemic events, heart failure, or death.</p

Cox proportional hazards model for the incidence of acute ischaemic events.

<p>Cox proportional hazards model for the incidence of acute ischaemic events.</p