Cardiovascular Outcomes and Mortality in Patients Using Clopidogrel With Proton Pump Inhibitors After Percutaneous Coronary Intervention or Acute Coronary Syndrome
Cardiovascular Outcomes and Mortality in Patients Using Clopidogrel With Proton Pump Inhibitors After Percutaneous Coronary Intervention or Acute Coronary Syndrome
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DOI：
10.1161/circulationaha.109.873497
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发表时间：
2009-12-08
期刊：
影响因子：
37.8
通讯作者：
Schneeweiss, Sebastian
中科院分区：
文献类型：
--
作者：
Rassen, Jeremy A.;Choudhry, Niteesh K.;Schneeweiss, Sebastian
背景-最近的研究提出了对与质子泵抑制剂(PPI)同时使用氯吡格雷降低疗效的担忧，但这些研究可能高估了这种风险。方法和结果-我们研究了2001-2005年间接受治疗的3个年龄为65岁的患者中，同时使用PPI和不同时使用PPI的氯吡格雷使用者中不良心血管事件风险增加的可能性。所有患者都接受过经皮冠状动脉介入治疗，或曾在宾夕法尼亚州、新泽西州或不列颠哥伦比亚省因急性冠状动脉综合征住院，随后开始使用氯吡格雷治疗。我们记录了使用PPI和不使用PPI的患者的心肌梗死住院、死亡和血管重建情况。我们使用特定队列和合并回归分析来评估我们的心肌梗死、住院或死亡的主要终点。我们将18565名氯吡格雷使用者纳入我们的分析。在合并的基础上，同时开始PPI的患者中，2.6%的患者心肌梗死住院，而不使用PPI的患者为2.1%；1.5%的患者死亡；3.4%的患者接受血管重建。心肌梗死或死亡的主要终点倾向积分调整比率为1.22(95%可信区间，0.99至1.51)；死亡倾向，1.20(95%可信区间，0.84至1.70)；血管重建，0.97(95%可信区间，0.79至1.21)。配对分析通常得出相似的结果。结论：尽管点数估计显示同时使用氯吡格雷和PPI的老年患者心肌梗死、住院或死亡的风险略有增加，但我们没有观察到氯吡格雷和PPI相互作用具有重大临床相关性的确凿证据。我们的数据表明，如果这种效应存在，风险增加不太可能超过20%。(发行量。2009年；120：2322-2329。)
Background-Recent studies have raised concerns about the reduced efficacy of clopidogrel when used concurrently with proton pump inhibitors (PPIs), but those studies may have overestimated the risk.Methods and Results-We studied the potential for increased risk of adverse cardiovascular events among users of clopidogrel with versus without concurrent use of PPIs in 3 large cohorts of patients >= 65 years of age, treated between 2001 and 2005. All patients had undergone percutaneous coronary intervention or had been hospitalized for acute coronary syndrome in Pennsylvania, New Jersey, or British Columbia, and subsequently had initiated treatment with clopidogrel. We recorded myocardial infarction hospitalization, death, and revascularization among PPI users and nonusers. We assessed our primary end point of myocardial infarction hospitalization or death using cohort-specific and pooled regression analyses. We entered 18 565 clopidogrel users into our analysis. On a pooled basis, 2.6% of those who also initiated a PPI versus 2.1% of PPI nonusers had a myocardial infarction hospitalization; 1.5% versus 0.9% died; and 3.4% versus 3.1% underwent revascularization. The propensity score-adjusted rate ratio for the primary end point of myocardial infarction or death was 1.22 (95% confidence interval, 0.99 to 1.51); for death, 1.20 (95% confidence interval, 0.84 to 1.70); and for revascularization, 0.97 (95% confidence interval, 0.79 to 1.21). Matched analyses generally yielded similar results.Conclusions-Although point estimates indicated a slightly increased risk of myocardial infarction hospitalization or death in older patients initiating both clopidogrel and a PPI, we did not observe conclusive evidence of a clopidogrel-PPI interaction of major clinical relevance. Our data suggest that if this effect exists, it is unlikely to exceed a 20% risk increase. (Circulation. 2009; 120: 2322-2329.)