title: Proton pump inhibitors for patients with coronary artery disease associated with reduced chest pain, emergency department visits, and hospitalizations.
abstract: 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.
  
  
  OBJECTIVE
  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.
authors.affiliation: Department of Medicine, Division of Cardiology, Saint Vincent Catholic Medical Centers, Comprehensive Cardiovascular Center, New York, NY 10011, USA. jliu2006@yahoo.com
authors.forename: John P
authors.initials: JP
authors.lastname: Liuzzo
authors.forename: John A
authors.initials: JA
authors.lastname: Ambrose
authors.forename: Paul
authors.initials: P
authors.lastname: Diggs
mesh_terms: D000368:Aged; D002637:Chest Pain / Q000517:prevention & control; D003327:Coronary Disease / Q000188:drug therapy* / Q000453:epidemiology; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005764:Gastroesophageal Reflux / Q000453:epidemiology; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D054328:Proton Pump Inhibitors; D012189:Retrospective Studies
chemical_list: D054328:Proton Pump Inhibitors