Proton-Pump Inhibitors Are Associated With Increased Cardiovascular Risk Independent of Clopidogrel Use A Nationwide Cohort Study
Proton-Pump Inhibitors Are Associated With Increased Cardiovascular Risk Independent of Clopidogrel Use A Nationwide Cohort Study
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DOI：
10.7326/0003-4819-153-6-201009210-00005
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发表时间：
2010-09-21
影响因子：
39.2
通讯作者：
Gislason, Gunnar
中科院分区：
文献类型：
--
作者：
Charlot, Mette;Ahlehoff, Ole;Gislason, Gunnar
背景资料：关于氯吡格雷和质子泵抑制剂（PPI）的双重使用是否会影响氯吡格雷的临床疗效仍存在争议。目的：在因心肌梗死住院的成人中，研究与单独使用PPI相比，同时使用PPI和氯吡格雷相关的不良心血管结局风险。设计：基于相关行政登记数据的全国性队列研究。设置：丹麦的所有医院。患者：2000年至2006年首次心肌梗死后所有患者均出院。测量：主要结局是因心肌梗死或中风或心血管死亡而再次住院的综合结果。在心肌梗死后7、14、21和30天的几个组装时间点对患者进行检查。结果：在56406例患者中，9137例（16.2%）因心肌梗死或卒中再次住院或发生心血管死亡。在接受氯吡格雷的24702例患者（43.8%）中，6753例（27.3%）接受伴随PPI。在出院后第30天收集的队列中，伴随使用PPI和氯吡格雷的心血管死亡或因心肌梗死或卒中再次住院的风险比为1.29（95% CI，1.17 - 1.42）。未接受氯吡格雷治疗的患者使用PPI的相应比率为1.29（CI，1.21 - 1.37）。PPI和氯吡格雷之间没有统计学显著的相互作用（P = 0.72）。局限性：未测量和残留的混杂，随时间变化的测量误差的曝光，并从生存effects.Conclusion偏差是可能的：质子泵抑制剂似乎与出院后不良心血管结局的风险增加，无论氯吡格雷用于心肌梗死。PPI和氯吡格雷的双重使用与仅使用PPI的患者观察到的任何额外的心血管不良事件风险无关。
Background: Controversy remains on whether the dual use of clopidogrel and proton-pump inhibitors (PPIs) affects clinical efficacy of clopidogrel.Objective: To examine the risk for adverse cardiovascular outcomes related to concomitant use of PPIs and clopidogrel compared with that of PPIs alone in adults hospitalized for myocardial infarction.Design: A nationwide cohort study based on linked administrative registry data.Setting: All hospitals in Denmark.Patients: All patients discharged after first-time myocardial infarction from 2000 to 2006.Measurements: The primary outcome was a composite of re-hospitalization for myocardial infarction or stroke or cardiovascular death. Patients were examined at several assembly time points, including 7, 14, 21, and 30 days after myocardial infarction. Follow-up was 1 year.Results: Of 56 406 included patients, 9137 (16.2%) were re-hospitalized for myocardial infarction or stroke or experienced cardiovascular death. Of the 24 702 patients (43.8%) who received clopidogrel, 6753 (27.3%) received concomitant PPIs. The hazard ratio for cardiovascular death or rehospitalization for myocardial infarction or stroke for concomitant use of a PPI and clopidogrel among the cohort assembled at day 30 after discharge was 1.29 (95% CI, 1.17 to 1.42). The corresponding ratio for use of a PPI in patients who did not receive clopidogrel was 1.29 (CI, 1.21 to 1.37). No statistically significant interaction occurred between a PPI and clopidogrel (P = 0.72).Limitations: Unmeasured and residual confounding, time-varying measurement errors of exposure, and biases from survival effects were possible.Conclusion: Proton-pump inhibitors seem to be associated with increased risk for adverse cardiovascular outcomes after discharge, regardless of clopidogrel use for myocardial infarction. Dual PPI and clopidogrel use was not associated with any additional risk for adverse cardiovascular events over that observed for patients prescribed a PPI alone.