Proton pump inhibitors for patients with coronary artery disease associated with reduced chest pain, emergency department visits, and hospitalizations

BACKGROUND: Patients with coronary artery disease (CAD) presenting to an emergency department (ED) with chest pain are likely to undergo hospitalization as clinicians attempt to elucidate the etiology. HYPOTHESIS: We hypothesized that proton pump inhibitor (PPI) therapy is associated with reduced chest pain events and evaluations in patients with CAD. METHODS: A patient population from a veterans medical center with documented CAD was identified retrospectively, and chest pain episodes, ED visits, and hospitalizations for chest pain were prospectively followed over 2 years. Comparison of patient outcomes between PPI (+PPI) and nonuse of PPI therapy (-PPI) was determined. RESULTS: Of 415 male patients, average age 73.4 years, 23% utilized a PPI and 77% did not. Proton pump inhibitor therapy was associated with reduced chest pain episodes (11.8 vs. 26.2%, p = 0.002), ED visits (12.3 vs. 24.3%, p = 0.044), and hospitalizations (12.8 vs. 23.9%, p = 0.086). Relative reductions were 55, 49, and 46%, respectively, after 2 years. Numbers of adverse events were also decreased in the +PPI group of patients: 70% fewer occurrences of chest pain (p = 0.002, relative risk RR] = 3.3), 55% fewer ED visits (p = 0.049, RR = 2.2), and 53% fewer hospitalizations (p = 0.064, RR = 2.1). By multivariate analysis, PPI therapy independently predicted reduced prevalence of patients experiencing chest pain, ED visits, or hospitalizations (odds ratio OR] = 0.09 0.04-0.21]; 0.15 0.06-0.40]; 0.14 0.05-0.40]; all p < 0.001). CONCLUSIONS: Proton pump inhibitor therapy for male patients with CAD from a veterans medical center was associated with reduced prevalence of chest pain, ED visits, and hospitalizations for chest pain and reduced incidence of these events.