Department of Cardiology, Heart Center, Academic Medical Center-University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
Department of Cardiology, Radboud University Medical Center, Geert Grooteplein 10, Nijmegen, The Netherlands.
Eur Heart J Cardiovasc Pharmacother. 2019 Jul 1;5(3):127-138. doi: 10.1093/ehjcvp/pvy030.
Proton-pump inhibitors (PPIs) are commonly prescribed in acute coronary syndrome (ACS) patients on antiplatelet therapy. We studied PPI prescription in ACS patients in the era of novel P2Y12 inhibitors and assessed the association between PPI use and clinical outcomes.
Between 2010 and 2014, we included all consecutive ACS patients admitted to a Dutch tertiary hospital. The main outcome was PPI prescription at discharge. Additionally, we present 1-year mortality and 30-day cardiovascular and bleeding outcomes. Of 4595 ACS patients with known discharge medication, 63.9% received a PPI. PPI-treated patients were older (67.1 ± 12.5 vs. 63.0 ± 13.3, P < 0.001). PPI treatment at discharge increased from 34.7% in 2010 to 88.7% in 2014 (P < 0.001). Concurrently, ticagrelor prescription at discharge increased from 0.0% to 48.6% in 2014 (P < 0.001), while clopidogrel prescription decreased from 78.6% in 2010 to 28.7% in 2014 (P < 0.001). PPI treatment was associated with reductions in death or myocardial infarction (MI) [adjusted hazard ratio (HR) 0.27, 95% confidence interval (CI) 0.10-0.76] and death, MI or stroke (adjusted HR 0.33, 95% CI 0.14-0.81) at 30-days post-discharge. However, this association was not present in subgroup analyses of patients treated with clopidogrel or ticagrelor.
In this single-centre registry, PPI prescription in ACS patients doubled between 2010 and 2014. PPI treatment at discharge was associated with a reduction in death, MI, or stroke at 30-days post-discharge, mainly driven by a reduction in MI. There were no differences gastrointestinal bleeding between patients treated with or without a PPI. PPI treatment may serve as a marker of improved therapies and outcome, rather than causing a reduction in cardiovascular events.
质子泵抑制剂 (PPI) 常用于接受抗血小板治疗的急性冠脉综合征 (ACS) 患者。我们研究了新型 P2Y12 抑制剂时代 ACS 患者中 PPI 的处方情况，并评估了 PPI 使用与临床结局之间的关系。
在 2010 年至 2014 年间，我们纳入了荷兰一家三级医院连续收治的所有 ACS 患者。主要结局为出院时的 PPI 处方。此外，我们还报告了 1 年死亡率和 30 天心血管和出血结局。在已知出院用药的 4595 例 ACS 患者中，63.9%接受了 PPI 治疗。与未接受 PPI 治疗的患者相比，接受 PPI 治疗的患者年龄更大（67.1±12.5 岁 vs. 63.0±13.3 岁，P<0.001）。出院时 PPI 治疗的比例从 2010 年的 34.7%增加到 2014 年的 88.7%（P<0.001）。同时，出院时替格瑞洛的处方比例从 2014 年的 0.0%增加到 48.6%（P<0.001），而氯吡格雷的处方比例从 2010 年的 78.6%下降到 2014 年的 28.7%（P<0.001）。PPI 治疗与 30 天内死亡或心肌梗死（MI）[调整后的危险比（HR）0.27，95%置信区间（CI）0.10-0.76]和出院后 30 天内死亡、MI 或卒中（调整后的 HR 0.33，95% CI 0.14-0.81）的风险降低相关。然而，在接受氯吡格雷或替格瑞洛治疗的患者亚组分析中，这种相关性并不存在。
在这项单中心注册研究中，ACS 患者中 PPI 的处方在 2010 年至 2014 年间增加了一倍。出院时使用 PPI 与 30 天内死亡、MI 或卒中风险降低相关，主要与 MI 减少有关。接受或不接受 PPI 治疗的患者之间的胃肠道出血无差异。PPI 治疗可能是治疗效果和预后改善的标志，而不是导致心血管事件减少的原因。
