%0 Journal Article
%T Long-Term Effects of Proton Pump Inhibitors in Patients Undergoing Percutaneous Coronary Intervention in High-Risk Subgroups.
%A Yamamoto K
%A Yamamoto E
%A Morimoto T
%A Shiomi H
%A Domei T
%A Taniguchi R
%A Sakai H
%A Toyofuku M
%A Kaji S
%A Nawada R
%A Yokomatsu T
%A Suwa S
%A Furukawa Y
%A Kadota K
%A Ando K
%A Kimura T
%A  
%J Circ J
%V 0
%N 0
%D 2024 Aug 6
%M 39111853
%F 3.35
%R 10.1253/circj.CJ-24-0371
%X <B>BACKGROUND: </B>Proton pump inhibitors (PPIs) reportedly reduce upper gastrointestinal bleeding (UGIB) in patients undergoing percutaneous coronary intervention (PCI). However, whether the benefits of PPIs differ in high-risk subgroups is unknown.<BR><B>RESULTS: </B>Among 24,563 patients undergoing first PCI in the CREDO-Kyoto registry Cohort-2 and -3, we evaluated long-term effects of PPI for UGIB, defined as GUSTO moderate/severe bleeding, in several potential high-risk subgroups. In the study population, 45.6% of patients were prescribed PPIs. Over a median 5.6-year follow-up, PPIs were associated with lower adjusted risk of UGIB (hazard ratio [HR] 0.64; 95% confidence interval [CI] 0.50-0.80; P<0.001) and a non-significant but numerically lower risk of any gastrointestinal bleeding (HR 0.84; 95% CI 0.71-1.01; P=0.06). PPIs were not associated with a lower risk of GUSTO moderate/severe bleeding (HR 1.04; 95% CI 0.94-1.15; P=0.40) or a higher adjusted risk of myocardial infarction or ischemic stroke (HR 1.00; 95% CI 0.90-1.12; P=0.97), but were associated with higher adjusted mortality risk (HR 1.18; 95% CI 1.09-1.27; P<0.001). The effects of PPIs for UGIB, myocardial infarction or ischemic stroke, and all-cause death were consistent regardless of age, sex, acute coronary syndrome, high bleeding risk, oral anticoagulant use, and type of P2Y12inhibitor.<BR><B>CONCLUSIONS: </B>PPIs were associated with a lower risk of UGIB and a neutral risk of ischemic events regardless of high-risk subgroup.