Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, the Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China; Vanke School of Public Health, Tsinghua University.
Department of Gastroenterology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Mayo Clin Proc. 2022 Apr;97(4):682-692. doi: 10.1016/j.mayocp.2021.11.037. Epub 2022 Feb 12.
To evaluate the association between proton pump inhibitor (PPI) use and in-hospital gastrointestinal (GI) bleeding in patients with acute coronary syndrome (ACS) taking dual antiplatelet therapy (DAPT).
This study is based on the Improving Care for Cardiovascular Disease in China-ACS project, an ongoing collaborative registry and quality improvement project of the American Heart Association and the Chinese Society of Cardiology. A total of 25,567 patients with ACS taking DAPT from 172 hospitals from July 1, 2017, through December 31, 2018, were included. Multivariable Cox regression and propensity score-matched analyses were used to evaluate the association between PPI use and in-hospital GI bleeding.
Of these patients with ACS, 63.9% (n=16,332) were prescribed PPIs within 24 hours of admission. Patients using PPIs had a higher rate of GI bleeding compared with those not using PPIs (1.0% vs 0.5%; P<.001). In the multivariable Cox regression analysis, early PPI use was associated with a 58% higher risk of GI bleeding (hazard ratio, 1.58; 95% CI, 1.15 to 2.18; P=.005). Further propensity score matching attenuated the association but still showed that patients using PPIs had a higher rate of GI bleeding (0.8% vs 0.6%; P=.04).
In China, PPIs are widely used within 24 hours of admission in patients with ACS taking DAPT. An increased risk of GI bleeding is observed in inpatients with early PPI use. Randomized trials on early use of PPIs in patients with ACS receiving DAPT are warranted.
clinicaltrials.gov Identifier: NCT02306616.
评估质子泵抑制剂（PPI）在服用双联抗血小板治疗（DAPT）的急性冠状动脉综合征（ACS）患者中的使用与院内胃肠道（GI）出血之间的关系。
本研究基于正在进行的美国心脏协会和中华心血管病学会合作注册和质量改进项目——改善中国心血管疾病管理-ACS 项目。纳入 2017 年 7 月 1 日至 2018 年 12 月 31 日来自 172 家医院的 25567 例 ACS 患者，他们均接受 DAPT 治疗。采用多变量 Cox 回归和倾向评分匹配分析来评估 PPI 使用与院内 GI 出血之间的关系。
在这些 ACS 患者中，63.9%（n=16332）在入院后 24 小时内开具了 PPI。与未使用 PPI 的患者相比，使用 PPI 的患者 GI 出血发生率更高（1.0%比 0.5%；P<.001）。多变量 Cox 回归分析显示，早期使用 PPI 与 GI 出血风险增加 58%相关（危险比，1.58；95%CI，1.15 至 2.18；P=.005）。进一步的倾向评分匹配减弱了这种关联，但仍显示使用 PPI 的患者 GI 出血发生率更高（0.8%比 0.6%；P=.04）。
在中国，ACS 患者接受 DAPT 治疗时，PPI 在入院后 24 小时内广泛使用。早期使用 PPI 的住院患者发生 GI 出血的风险增加。有必要进行随机试验以评估 DAPT 治疗的 ACS 患者早期使用 PPI 的情况。
clinicaltrials.gov 标识符：NCT02306616。
