title: Prospective, randomized, placebo-controlled evaluation of esomeprazole in coronary artery disease patients. EPAC: esomeprazole prevention of atypical chest pains.
abstract: BACKGROUND
  Coronary artery disease (CAD) patients experience chest pain (CP) from cardiac and non-cardiac etiologies.
  
  
  OBJECTIVE
  Proton pump inhibitor (PPI) treatment of CAD patients with atypical CP would result in less CP, as well as fewer emergency room (ER) visits for CP, medical evaluations, and hospitalizations.
  
  
  METHODS
  A randomized, prospective, placebo-controlled trial in patients with a history of severe CAD, without current ischemia, and not receiving acid reducing therapy. Patients received esomeprazole 40 mg or placebo daily added to standard cardiac medications for 6 months. The primary endpoint was percentage of patients experiencing CP.
  
  
  RESULTS
  In 162 patients randomized, 78 received esomeprazole and 84 received placebo. Esomeprazole significantly reduced the primary endpoint of patients experiencing CP (24.4% versus 54.8%; p < 0.001). The absolute number of CP episodes and CP days was also significantly reduced. Fewer patients experienced the combined endpoint of doctor office/ER visits for CP (19.2% versus 48.8%; p < 0.001), mainly due to significantly fewer office visits for CP (14.1% versus 39.3%; p < 0.001). ER visits for CP trended less with esomeprazole (12.8% versus 22.6%; p = 0.10), as did hospitalizations for CP (14.1% versus 20.2%; p = 0.30). However, the study lacked statistical power to reach these secondary endpoints.
  
  
  CONCLUSIONS
  Concomitant esomeprazole therapy in CAD patients without active ischemia but with a history of atypical CP reduces number of patients with further CP symptoms and medical office visits for CP. Larger studies are needed to further evaluate PPI treatment on ER CP visits and hospitalizations in this patient population.
authors.affiliation: Saint Vincent Catholic Medical Centers, New York, New York, USA. jliu2006@yahoo.com
authors.forename: John
authors.initials: J
authors.lastname: Liuzzo
authors.forename: John
authors.initials: J
authors.lastname: Ambrose
authors.forename: Sajal
authors.initials: S
authors.lastname: Das
authors.forename: Mary
authors.initials: M
authors.lastname: Devoe
authors.forename: Ravi
authors.initials: R
authors.lastname: Korabathina
authors.forename: Saurabh
authors.initials: S
authors.lastname: Agarwal
authors.forename: Srmiti
authors.initials: S
authors.lastname: Deshmukh
authors.forename: John
authors.initials: J
authors.lastname: Coppola
mesh_terms: D000897:Anti-Ulcer Agents / Q000008:administration & dosage*; D002637:Chest Pain / Q000150:complications / Q000188:drug therapy* / Q000517:prevention & control*; D003324:Coronary Artery Disease / Q000150:complications; D004359:Drug Therapy, Combination; D064098:Esomeprazole / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
chemical_list: D000897:Anti-Ulcer Agents; D064098:Esomeprazole