Shi Wence, Ni Lin, Yang Jingang, Fan Xiaoxue, Yu Mei, Yang Hongmei, Yu Mengyue, Yang Yuejin
Department of Cardiology, Medical Research and Biometrics Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Medical Research and Biometrics Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Front Cardiovasc Med. 2021 Sep 22;8:685072. doi: 10.3389/fcvm.2021.685072. eCollection 2021.
The latest guidelines recommend the use of proton pump inhibitors (PPIs) to minimize gastrointestinal bleeding (GIB) in patients receiving dual antiplatelet therapy (DAPT), even though this co-administration may increase the risk of ischemia due to drug interactions. We have noticed that there are few studies conducted on patients with a lower risk of GIB. Therefore, we investigated the clinical effect of co-administration of PPI on DAPT patients with low GIB risk. From January 2013 to September 2014, a total of 17,274 consecutive patients on DAPT from 108 hospitals with low risk for GIB in the China Acute Myocardial Infarction (CAMI) registry were analyzed. The primary endpoints were GIB and major adverse cardiovascular and cerebrovascular events (MACCE). Multivariate logistic regression analysis and Cox proportional hazard models were used to assess the effect of PPIs use. Of the analyzed patients, 66.6% ( = 11,487) were treated with PPIs. PPI use did not show an extra gastrointestinal protective effect in patients with low risk for GIB who were hospitalized and on follow-up after 2 years. Moreover, it was associated with an increased risk of stroke during the 2-year follow-up [hazard ratio (HR) 2.072, 95% confidence interval (CI) 1.388-3.091, = 0.0003] and an increased risk of MI after 6 months (HR 1.580, 95% CI 1.102-2.265, = 0.0119). We found the same results after propensity score matching. PPI use is prevalent in DAPT patients with low GIB risk. PPIs did not show an extra gastrointestinal protective effect, while an increased risk of stroke was observed during the 2-year follow-up. www.clinicaltrials.gov, identifier NCT01874691.
最新指南建议，在接受双联抗血小板治疗（DAPT）的患者中使用质子泵抑制剂（PPI），以尽量减少胃肠道出血（GIB），尽管这种联合用药可能因药物相互作用而增加缺血风险。我们注意到，针对GIB风险较低的患者开展的研究较少。因此，我们调查了PPI联合用药对GIB风险较低的DAPT患者的临床效果。2013年1月至2014年9月，对中国急性心肌梗死（CAMI）注册研究中108家医院连续纳入的17274例GIB风险较低的DAPT患者进行了分析。主要终点为GIB和主要不良心血管和脑血管事件（MACCE）。采用多因素逻辑回归分析和Cox比例风险模型评估使用PPI的效果。在分析的患者中，66.6%（n = 11487）接受了PPI治疗。对于住院且随访2年的GIB低风险患者，使用PPI并未显示出额外的胃肠道保护作用。此外，在2年随访期间，使用PPI与中风风险增加相关[风险比（HR）2.072，95%置信区间（CI）1.388 - 3.091，P = 0.0003]，且在6个月后心肌梗死风险增加（HR 1.580，95% CI 1.102 - 2.265，P = 0.0119）。倾向评分匹配后我们得到了相同的结果。在GIB风险较低的DAPT患者中，PPI的使用很普遍。PPI未显示出额外的胃肠道保护作用，而在2年随访期间观察到中风风险增加。临床试验.gov，标识符NCT01874691。
