Association of proton pump inhibitor use with disease burden and cardiometabolic profile among patients hospitalized for acute myocardial infarction

    Authors

    Keywords

    acute coronary syndrome, acute myocardial infarction, IPP, proton pump inhibitors, outcomes

    DOI

    https://doi.org/10.15836/ccar2021.5

    Full Text

    Introduction : Previous studies showed an increased likelihood and risk of acute myocardial infarction (AMI) and hospitalizations for cardiovascular events among patients exposed to chronic use of proton pump inhibitors (PPIs). ( 1 - 3 ) In this study we aimed to compare parameters reflecting disease burden and cardiometabolic profile among patients treated for AMI with respect to the chronic exposure to PPIs. Patients and Methods : Data of 143 adult consecutive patients hospitalized for ST-elevation myocardial infarction (STEMI) or non-ST-segment elevation myocardial infarction (NSTEMI) during the 2019-2020 period were analyzed. All continuous variables had a normal distribution. Results : The mean age was 64.8 ± 11.3 years and 79.7% were men. Two-thirds (65.7%) of patients had STEMI while 34.3% had NSTEMI. The mean GRACE score in the whole cohort was 117 ± 26 points while 12.6% of patients were at high risk of in-hospital death, after adjustment for the ACS type. A total of 19 IPP+ patients were identified. Patients in the IPP+ group were significantly older and had a higher prevalence of NSTEMI compared to IPP- group while both groups did not significantly differ in terms of sex, body mass index, waist-to-hip ratio, the mean number of diseased vessels at angiography, and left ventricular ejection fraction. Patient IPP+ group had a significantly higher high-sensitivity cardiac troponin I rise from 1 st to 2 nd measurement compared to IPP- group (4726 ± 5938 vs. 2554 ± 3480 ng/L, p=0.025, Table 1 ). Furthermore, C-reactive protein, blood glucose, and serum creatinine levels at admission were significantly higher in IPP+ vs. the IPP- group. Finally, patients in the IPP+ group had a significantly higher risk of in-hospital and 6-month post-discharge death compared to IPP- group, as adjudicated by the GRACE score (132 ± 23 vs. 114 ± 26 points, p=0.008). Conclusions : Our study showed that AMI patients with chronic exposure to IPPs are older, mostly male, and tend to present with NSTEMI. These patients exhibit a larger magnitude of myocardial injury and systemic inflammation accompanied by worse renal function, and also seem to be at an increased risk of poor in-hospital and post-discharge outcomes. However, potential confounding of underlying comorbidities and age must be taken into account when interpreting these results.

    Cardiologia Croatica
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    Association of proton pump inhibitor use with disease burden and cardiometabolic profile among patients hospitalized for acute myocardial infarction

    Extended Abstract
    Issue1-2
    Published
    Pages5
    PDF via DOIhttps://doi.org/10.15836/ccar2021.5
    acute coronary syndrome
    acute myocardial infarction
    IPP
    proton pump inhibitors
    outcomes

    Authors

    Admira BilalićORCIDUniversity Hospital Centre Split, Split, Croatia
    Josip Anđelo Borovac*ORCIDUniversity of Split School of Medicine, Split, Croatia
    Tina Tičinović KurirORCIDUniversity of Split School of Medicine, Split, Croatia
    Marko KumrićORCIDUniversity of Split School of Medicine, Split, Croatia
    Andrija MatetićORCIDUniversity Hospital Centre Split, Split, Croatia
    Joško BožićORCIDUniversity of Split School of Medicine, Split, Croatia

    Full Text

    Introduction : Previous studies showed an increased likelihood and risk of acute myocardial infarction (AMI) and hospitalizations for cardiovascular events among patients exposed to chronic use of proton pump inhibitors (PPIs). ( 1 - 3 ) In this study we aimed to compare parameters reflecting disease burden and cardiometabolic profile among patients treated for AMI with respect to the chronic exposure to PPIs. Patients and Methods : Data of 143 adult consecutive patients hospitalized for ST-elevation myocardial infarction (STEMI) or non-ST-segment elevation myocardial infarction (NSTEMI) during the 2019-2020 period were analyzed. All continuous variables had a normal distribution. Results : The mean age was 64.8 ± 11.3 years and 79.7% were men. Two-thirds (65.7%) of patients had STEMI while 34.3% had NSTEMI. The mean GRACE score in the whole cohort was 117 ± 26 points while 12.6% of patients were at high risk of in-hospital death, after adjustment for the ACS type. A total of 19 IPP+ patients were identified. Patients in the IPP+ group were significantly older and had a higher prevalence of NSTEMI compared to IPP- group while both groups did not significantly differ in terms of sex, body mass index, waist-to-hip ratio, the mean number of diseased vessels at angiography, and left ventricular ejection fraction. Patient IPP+ group had a significantly higher high-sensitivity cardiac troponin I rise from 1 st to 2 nd measurement compared to IPP- group (4726 ± 5938 vs. 2554 ± 3480 ng/L, p=0.025, Table 1 ). Furthermore, C-reactive protein, blood glucose, and serum creatinine levels at admission were significantly higher in IPP+ vs. the IPP- group. Finally, patients in the IPP+ group had a significantly higher risk of in-hospital and 6-month post-discharge death compared to IPP- group, as adjudicated by the GRACE score (132 ± 23 vs. 114 ± 26 points, p=0.008). Conclusions : Our study showed that AMI patients with chronic exposure to IPPs are older, mostly male, and tend to present with NSTEMI. These patients exhibit a larger magnitude of myocardial injury and systemic inflammation accompanied by worse renal function, and also seem to be at an increased risk of poor in-hospital and post-discharge outcomes. However, potential confounding of underlying comorbidities and age must be taken into account when interpreting these results.