The association between proton pump inhibitors use on outcomes following carotid endarterectomy for carotid stenosis: a population-based cohort study

Carotid endarterectomy (CEA) is effective in treating carotid stenosis and preventing future stroke. Proton pump inhibitor (PPI) is frequently prescribed among the general population. However, the association of PPI use on outcomes following CEA for carotid stenosis remains unclear. This is a retrospective, propensity-matched analysis conducted using the TriNetX research network. Propensity score matching (PSM) was employed to form two balanced groups for comparison between PPI users and non-PPI users undergoing CEA for carotid stenosis. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using the TriNetX platform to compare cerebrovascular and cardiovascular outcomes. The crude cohort included a total of 9125 patients. After PSM, 1666 patients were eligible in both PPI user and non-PPI user cohorts. The mean age at CEA surgery was 69.5 years. Compared to the non-PPI users, PPI users were associated with a higher incidence of 30-day postoperative stroke (OR: 1.47; 95% CI 1.05–2.06; p = 0.023). Analyses of 2-year outcomes showed that PPI users were associated with a higher incidence of ischemic stroke (OR: 1.36; 95% CI 1.04–1.78; p = 0.025); and a mild trend towards a higher incidence of myocardial infarction (OR: 1.49; 95% CI 0.97–2.28; p = 0.085). In patients who underwent CEA for carotid stenosis without previous stroke, PPI use was associated with an increased risk of stroke in both 30-day postoperative period and 2-year follow-up. These findings are hypothesis-generating and should be interpreted with caution given the observational design and potential residual confounding.