Division of Gastroenterology, Taichung Veterans General Hospital, Taichung, Taiwan.
Gastroenterology. 2010 Oct;139(4):1165-71. doi: 10.1053/j.gastro.2010.06.067. Epub 2010 Jun 30.
BACKGROUND & AIMS: Previous observational studies reported that concomitant use of clopidogrel and proton pump inhibitors (PPIs) in patients with prior acute coronary syndrome (ACS) was associated with adverse cardiovascular outcomes. We investigated whether H(2)-receptor antagonist (H(2)RA) is an alternative to PPI in patients with ACS.
We conducted a population-based retrospective cohort study of 6552 patients in Taiwan discharged for ACS between 2002 and 2005. Patients were divided into 5 cohorts: clopidogrel plus H(2)RA (n = 252), clopidogrel plus PPI (n = 311), clopidogrel alone (n = 5551), H(2)RA alone (n = 235), and PPI alone (n = 203). The primary outcome was rehospitalization for ACS or all-cause mortality within 3 month of rehospitalization.
The 1-year cumulative incidence of the primary outcome was 26.8% (95% CI: 21.5%-33.0%) in the clopidogrel plus H(2)RA cohort and 33.2% (95% CI: 27.8%-39.4%) in the clopidogrel plus PPI cohort, compared with 11.6% (95% CI: 10.8%-12.5%) in the clopidogrel alone cohort (P < .0001). No significant difference was observed between the PPI alone cohort (11.0%; 95% CI: 7.1%-16.8%), the H(2)RA alone cohort (11.8%; 95% CI: 8.2%-16.8%), and the clopidogrel alone cohort in terms of the primary outcome. The number needed to harm was 7 with concomitant H(2)RA and 5 with concomitant PPI. On multivariate analysis, concomitant H(2)RA and PPI were independent risk factors predicting adverse outcomes (adjusted hazard ratios, 2.48 and 3.20, respectively; P < .0001).
Concomitant use of clopidogrel and H(2)RA or PPI after hospital discharge for ACS is associated with increased risk of adverse outcomes.
先前的观察性研究报告称，在既往急性冠脉综合征（ACS）患者中，氯吡格雷与质子泵抑制剂（PPIs）联合使用与心血管不良结局相关。我们研究了 H2-受体拮抗剂（H2RA）是否可替代 ACS 患者中的 PPI。
我们对台湾 2002 年至 2005 年期间出院的 6552 例 ACS 患者进行了一项基于人群的回顾性队列研究。患者分为 5 个队列：氯吡格雷加 H2RA（n=252）、氯吡格雷加 PPI（n=311）、氯吡格雷单药（n=5551）、H2RA 单药（n=235）和 PPI 单药（n=203）。主要结局是出院后 3 个月内因 ACS 或全因死亡率再次住院。
氯吡格雷加 H2RA 队列的 1 年累积主要结局发生率为 26.8%（95%CI：21.5%-33.0%），氯吡格雷加 PPI 队列为 33.2%（95%CI：27.8%-39.4%），而氯吡格雷单药队列为 11.6%（95%CI：10.8%-12.5%）（P<.0001）。PPI 单药队列（11.0%；95%CI：7.1%-16.8%）、H2RA 单药队列（11.8%；95%CI：8.2%-16.8%）和氯吡格雷单药队列在主要结局方面无显著差异。同时使用 H2RA 和 PPI 的危害人数需要 7 人，同时使用 H2RA 和 PPI 的危害人数需要 5 人。多变量分析显示，同时使用 H2RA 和 PPI 是预测不良结局的独立危险因素（调整后的危险比分别为 2.48 和 3.20；P<.0001）。
ACS 出院后同时使用氯吡格雷和 H2RA 或 PPI 与不良结局风险增加相关。
