The role of previous gastroscopy in evaluation of concomitant use of PPIs in patients with non-acute coronary syndrome after percutaneous coronary intervention

Abstract

Objective To evaluate previous gastroscopy before percutaneous coronary intervention （PCI） for the risks and benefits of concomitant use of proton pump inhibitors （PPIs） after PCI in patients with non-acute coronary syndrome （non-ACS）. Methods The data of 673 non-ACS patients who underwent PCI with stenting were retrospectively analyzed. They were divided into concomitant use of PPIs group and non-PPIs group, then subdivided into high-, moderate- and low-risk groups according to risk factors associat- ed with adverse upper gastrointestinal （GI） events. The incidences of adverse cardiovascular events and ad- verse upper GI events were compared among groups. Findings of previous gastroscopy were also included. Results Only 82 patients （12. 2% ） underwent gastroscopy within 5 years before PCI, of whom, 27 （32. 9% ） were diagnosed as having peptic ulcer, and 55. 6% （15/27） of whom were in concomitant use of PPIs. Compared with the non-PPIs group, the rate of adverse cardiovascular events in the concomitant useof PPIs group was significantly higher （22. 6% vs. 8. 9%, P 〈0. 01 ）, and the highest rate （41.7%） was in the high-risk group. However, the corresponding rate of adverse upper GI events was the lowest （4. 2% ）. In the moderate-risk group, 90.5% （344/380） of patients were older than 65 years with concomitant use of NSAIDs. The rate of gastroseopy within 5 years before PCI in these patients was remarkably lower than that in patients who had the history of upper GI disease with concomitant use of NSAIDs （ concomitant use of PPIs group 14. 1% vs. 54. 5% ;non-PPIs group 7. 5% vs. 28. 0% ;P 〈0. 01 ）. In the concomitant use of PPIs group, the rate of adverse cardiovascular events in the former was notably higher than that in the latter （20. 5% vs. 9. 1%, P 〈0.01 ）, but the rate of adverse upper GI events within 1 year after PCI were similar （9. 0% vs. 9. 1% ）. Conclusion Previous gastroseopy before PCI could provide the baseline information of upper GI disease, which may be helpful for the evaluation of concomitant use of PPIs after PCI so as to decrease the incidence of adverse cardiovascular events. Special attention should be paid to those patients older than 65 years in the moderate-risk group and concomitant use of NSAIDs. Key words: Gastroscopy; Non-acute coronary syndrome; Percutaneous coronary intervention; Proton pump inhibitors; Adverse cardiovascular events