Current status of proton pump inhibitor usage in patients with acute coronary syndrome and atrial fibrillation: a cross-sectional study.

BACKGROUND

The real-world status of proton pump inhibitor (PPI) administration in patients with acute coronary syndrome (ACS) and atrial fibrillation (AF) remains largely unknown.

OBJECTIVES

This study aimed to analyze the prescription pattern, trends and influencing factors of PPIs among Chinese patients with ACS and AF at discharge.

METHODS

This single-center, retrospective, cross-sectional study included patients with ACS and AF who were hospitalized at the Cardiovascular Center of Beijing Tongren Hospital from January 2010 to December 2018. All patients were subsequently categorized into two groups based on PPI administration at discharge (i.e., the PPI and non-PPI group), after which factors influencing PPI use were analyzed.

RESULTS

This study included 531 patients diagnosed with ACS and AF, with a median age of 73 years, 61.4% of these patients were male. Among them, 254 patients (47.8%) were administered PPIs. A significant increasing trend in PPI administration was observed from 21.3% (2010-2012) to 63.5% (2016-2018) (p < 0.001). Patients receiving PPIs were more likely to have non-ST-segment elevation myocardial infarction (UNSTEMI) [adjusted odds ratio (OR) 3.358, 95% confidence interval (CI) 1.819-6.196, p < 0.001], ST-elevation myocardial infarction (STEMI) [adjusted OR 4.092, 95% CI 2.177-7.694, p < 0.001], paroxysmal AF [adjusted OR 1.732, 95% CI 1.022-2.936, p = 0.041], GI disorders [adjusted OR 17.625, 95% CI 9.783-31.751, p < 0.001], were more likely to undergo catheter ablation [adjusted OR 13.368, 95% CI 3.836-46.586, p < 0.001] and more likely to receive oral anticoagulants [adjusted OR 1.918, 95% CI 1.006-3.658, p = 0.048] compared to those not receiving PPIs.

CONCLUSIONS

Our findings revealed that approximately 50% of patients with AF and ACS were prescribed PPI at discharge, highlighting the need to carefully evaluate the risks and benefits of combining antithrombotic medications and PPIs on an individual basis.