Impact of Proton Pump Inhibitor Use on Outcomes Following Carotid Artery Stenting for Asymptomatic Carotid Stenosis: A Population-Based Cohort Study

Carotid artery stenting (CAS) is an effective treatment for carotid stenosis. Proton-pump inhibitors (PPIs) are commonly prescribed in the general population. However, the impact of PPI use on outcomes following CAS remains unknown. This study investigated the impact of PPI use on CAS using a retrospective, matched-cohort analysis from the TriNetX research network. Propensity score matching (PSM) was employed to create two balanced cohorts consisting of regular PPI users and nonusers who underwent CAS for asymptomatic carotid stenosis. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using the TriNetX platform to compare cerebrovascular and cardiovascular outcomes. A total of 20,153 patients were included. After PSM, 4691 patients were included in both the PPI and non-PPI cohorts. The mean age at the time of CAS was 70.4 years in both groups. Compared with non-PPI users, patients in the PPI cohort had a higher incidence of 30-day periprocedural stroke (OR: 1.35; 95% CI: 1.08–1.69; p = 0.009). Analyses of 2-year outcomes demonstrated that regular PPI users had a higher incidence of ischemic stroke (OR: 1.16; 95% CI: 1.01–1.32; p = 0.034), transient ischemic attack (TIA) (OR: 1.30; 95% CI: 1.14–1.49; p < 0.001), and myocardial infarction (OR: 1.19; 95% CI: 1.03–1.38; p = 0.018) compared with non-PPI users. In patients undergoing CAS for asymptomatic carotid stenosis, PPI use was associated with an increased risk of periprocedural stroke, as well as a higher incidence of ischemic stroke, TIA, and myocardial infarction over a 2-year follow-up period.