Proton pump inhibitor use represents an independent risk factor for myocardial infarction
Proton pump inhibitor use represents an independent risk factor for myocardial infarction
复制标题
DOI：
10.1016/j.ijcard.2014.09.036
复制
发表时间：
2014-11-15
影响因子：
3.5
通讯作者：
Wang, Shuu-Jiun
中科院分区：
文献类型：
--
作者：
Shih, Chia-Jen;Chen, Yung-Tai;Wang, Shuu-Jiun
背景：在使用质子泵抑制剂(PPI)和氯吡格雷联合应用的患者中，关于急性冠脉综合征的发展存在很大的争议。然而，数据仍然仅限于PPI单独对随后的心肌梗死(MI)风险的影响。方法：从台湾国民健康保险研究资料库中检索2000-2009年间使用PPI处方的住院病人和门诊病人的资料。我们进行了两个不同的研究设计，第一个使用倾向分数(PS)匹配分析，第二个使用病例交叉分析。在PS配对研究中，分析了PPI使用者发生MI的风险。结果：在PS匹配的研究中，我们包括了126,367名PPI使用者和126,367名PS匹配的PPI非使用者。在120天的随访后，使用PPI与MI的风险增加了1.58倍(调整后的危险比[HR]=1.58，95%可信区间[CI]=1.11至2.25)。在病例交叉研究中，调整后的PPI对MI风险的优势比在7天窗口为4.61(95%CI=1.76~12.07)，在14天窗口为3.47(95%CI=1.76~6.83)。结论：使用PPI可能与MI风险增加独立相关。然而，PPI的好处可能远远超过心血管不良影响的风险，危害所需的数量为4357。(C)2014爱思唯尔爱尔兰有限公司。保留所有权利。
Background: There is substantial debate regarding the development of acute coronary syndrome in patients using proton pump inhibitors (PPIs) combined with clopidogrel. However, data remain limited to address the effect of PPIs alone on the subsequent risk of myocardial infarction (MI). We aimed to explore the subsequent risk of MI in PPI users who had no previous history of MI.Methods: The records of inpatients and outpatients with PPI prescriptions were retrieved from the Taiwan National Health Insurance Research Database between 2000 and 2009. We conducted two different study designs, the first using propensity score (PS)-matching analyses and the second using case-crossover analyses. The risk of developing MI for PPI users was analyzed in the PS-matched study. The association between risk of MI and prior PPI exposure was further validated in the case-crossover study.Results: In the PS-matched study, we included 126,367 PPI users and 126,367 PS-matched PPI non-users. After 120 days of follow-up, PPI use was associated with a 1.58-fold greater risk of MI (adjusted hazard ratio [HR] = 1.58, 95% confidence interval [CI] = 1.11 to 2.25). In the case-crossover study, adjusted odds ratios of PPI for MI risk were 4.61 (95% CI = 1.76 to 12.07) for the 7-day window and 3.47 (95% CI = 1.76 to 6.83) for the 14-day window.Conclusions: Use of PPIs may be independently associated with an increased risk of MI. However, the benefits of PPIs may greatly outweigh the risks of adverse cardiovascular effects, with number needed to harm of 4357. (C) 2014 Elsevier Ireland Ltd. All rights reserved.