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18.11.2019 | Original Article

Interaction between the effects of proton pump inhibitors and aspirin on gastric wall sestamibi uptake on myocardial perfusion imaging

Zeitschrift:
Journal of Nuclear Cardiology
Autoren:
MBBS David S. Rose, BMRS Brittany Robinson, MBBS Shanthi Kannan, MBBS Joseph C. Lee
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s12350-019-01951-1) contains supplementary material, which is available to authorized users.
The authors of this article have provided a PowerPoint file, available for download at SpringerLink, which summarises the contents of the paper and is free for re-use at meetings and presentations. Search for the article DOI on SpringerLink.com.
The authors have also provided an audio summary of the article, which is available to download as ESM, or to listen to via the JNC/ASNC Podcast.
All editorial decisions for this article, including selection of reviewers and the final decision, were made by guest editor Randall Thompson, MD.

Funding

Sources of funding for this research were nil.

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Abstract

Background

Increased gastric wall activity on myocardial perfusion imaging (MPI) is associated with proton pump inhibitor (PPI) therapy; however, the mechanism is unknown. We proposed a role for gastric mucosal prostaglandin synthesis and asked whether concurrent use of aspirin would antagonize this effect.

Methods

An observational study was performed of 319 patients undergoing technetium-99m sestamibi (MIBI) rest/stress MPI. We assessed the effects of taking PPIs, aspirin and their interaction on the principle outcome of clinically significant gastric wall activity.

Results

The outcome was observed in 13% of patients taking neither a PPI nor aspirin, 22% of those taking aspirin only, 51% taking a PPI only and 33% of those taking both. Adjusted odd ratios (95% confidence intervals) were 6.3 (CI 2.8-14.0; p < .001) for taking a PPI only, 1.8 (CI 0.8-3.9; p = .16) for taking aspirin only, and 3.0 (CI 1.4-6.5; p = .005) for taking the combination of a PPI and aspirin. There was evidence of negative statistical interaction between the two drug effects using additive (p = .006) and multiplicative (p = .016) scales.

Conclusions

PPI use was strongly associated with enhanced gastric wall activity on MPI; however, concurrent aspirin appears to reduce the effect. Enhanced local prostaglandin synthesis may mediate the PPI effect.

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