Association of the use of proton pump inhibitors with adverse cardiovascular and bleeding outcomes after percutaneous coronary intervention in the Japanese real world clinical practice
Association of the use of proton pump inhibitors with adverse cardiovascular and bleeding outcomes after percutaneous coronary intervention in the Japanese real world clinical practice
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DOI：
10.1007/s12928-011-0063-2
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发表时间：
2011-09-01
影响因子：
3.2
通讯作者：
Kita, Toru
中科院分区：
文献类型：
--
作者：
Kimura, Takeshi;Morimoto, Takeshi;Kita, Toru
既往研究显示，关于氯吡格雷和质子泵抑制剂（PPI）联合使用对心血管结局的影响，结果不一致。我们试图在一个大型日本观察数据库中评价PPI对经皮冠状动脉介入治疗（PCI）后接受噻吩并吡啶类药物治疗的患者的临床影响。在12446例接受噻吩并吡啶类药物（噻氯匹定90.4%和氯吡格雷9.6%）治疗的患者中，出院时3223例患者接受PPI治疗，9223例患者未接受PPI治疗。PPI组包含的合并症患者多于非PPI组。PPI使用对心血管死亡、心肌梗死和卒中复合事件的校正风险比（HR）为1.26（95%置信区间（CI）1.09-1.47，p = 0.002）。PPI用于出血的校正HR为1.26（95% CI 1.05-1.52，p = 0.013）。接受三种不同类型PPI的三组之间的心血管和出血结局没有差异。在两种药物洗脱支架（DES）中均观察到PPI对心血管结局的负面影响[HR 1.31（95% CI 1.07-1.6，p = 0.0097）]和非DES分层[HR 1.25（95% CI：0.99-1.57，p = 0.057）]（相互作用p = 0.79），尽管接受DES的患者中噻吩并吡啶给药的持续时间显著更长。总之，在日本真实的临床实践中，PPI患者PCI后的心血管结局显著差于未使用PPI的患者。然而，在接受PPI治疗的患者中观察到的心血管结局较差最可能与残留混杂因素有关，似乎与噻吩并吡啶通过与PPI相互作用减弱抗血小板作用无关。
Previous studies have shown inconsistent results regarding the effects of concomitant use of clopidogrel and proton pump inhibitors (PPI) on cardiovascular outcomes. We sought to evaluate the clinical impact of PPI-use in patients treated with thienopyridines after percutaneous coronary intervention (PCI) in a large Japanese observational database. Among 12446 patients discharged alive on thienopyridines (ticlopidine 90.4% and clopidogrel 9.6%), 3223 patients were treated with PPIs and 9223 patients without PPI at the time of hospital discharge. The PPI group included more patients with co-morbidities than the non-PPI group. The adjusted hazard ratio (HR) of PPI-use for a composite of cardiovascular death, myocardial infarction, and stroke was 1.26 (95% confidence interval (CI) 1.09-1.47, p = 0.002). The adjusted HR of PPI-use for bleeding was 1.26 (95% CI 1.05-1.52, p = 0.013). Cardiovascular and bleeding outcomes were not different among the three groups receiving three different types of PPI. The negative effect of PPI on cardiovascular outcome was consistently seen in both drugeluting stent (DES) [HR 1.31 (95% CI 1.07-1.6, p = 0.0097)] and non-DES strata [HR 1.25 (95% CI: 0.99-1.57, p = 0.057)] (Interaction p = 0.79) despite the fact that the duration of thienopyridine administration was significantly longer in patients receiving DES. In conclusion, cardiovascular outcomes after PCI were significantly worse in patients with PPI than in patients without PPI in the Japanese real clinical practice. However, the observed poorer cardiovascular outcome in patients receiving PPI was most likely to be related to residual confounding and seemed not causally related to attenuation of antiplatelet effect of thienopyridine through interaction with PPI.