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

  • David S. RoseEmail author
  • Brittany Robinson
  • Shanthi Kannan
  • Joseph C. Lee
Original Article



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.


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.


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.


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.


Myocardial perfusion imaging Sestamibi Proton pump inhibitors Aspirin Gastric wall Prostaglandin Artifact 



Methoxy-isobutyl-isonitrile (sestamibi)


Myocardial perfusion imaging


Single photon emission computerized tomography


Proton pump inhibitor


Non-steroidal anti-inflammatory drug

COX-1, COX-2

COX-1 and COX-2 isoenzyme of cyclooxygenase


Prostaglandin E2


Odds ratio



David S. Rose, Brittany Robinson, Shanthi Kannan and Joseph C. Lee have no conflicts of interest to declare.

Supplementary material

12350_2019_1951_MOESM1_ESM.pptx (1.4 mb)
Supplementary material 1 (PPTX 1403 kb)
12350_2019_1951_MOESM2_ESM.m4a (6.9 mb)
Supplementary material 2 (M4A 7064 kb)


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Copyright information

© American Society of Nuclear Cardiology 2019

Authors and Affiliations

  • David S. Rose
    • 1
    Email author
  • Brittany Robinson
    • 2
  • Shanthi Kannan
    • 1
    • 3
  • Joseph C. Lee
    • 1
    • 3
  1. 1.Department of Medical ImagingThe Prince Charles HospitalChermsideAustralia
  2. 2.Department of Nuclear MedicineRoyal Brisbane and Womens’ HospitalHerstonAustralia
  3. 3.Faculty of MedicineThe University of QueenslandHerstonAustralia

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