Impact of proton pump inhibitors on clinical outcomes in patients after acute myocardial infarction: a propensity score analysis from China Acute Myocardial Infarction(CAMI) registry

作     者：Wen-Ce SHI Si-De GAO Jin-Gang YANG Xiao-Xue FAN Lin NI Shu-Hong SU Mei YU Hong-Mei YANG Meng-Yue YU Yue-Jin YANG Wen-Ce SHI;Si-De GAO;Jin-Gang YANG;Xiao-Xue FAN;Lin NI;Shu-Hong SU;Mei YU;Hong-Mei YANG;Meng-Yue YU;Yue-Jin YANG

作者机构：Department of CardiologyState Key Laboratory of Cardiovascular DiseaseFuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina Medical Research and Biometrics CenterState Key Laboratory of Cardiovascular DiseaseFuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina Xinxiang Central HospitalXinxiangHenan ProvinceChina Langfang People’s HospitalLangfangHebei ProvinceChina First Hospital of QinhuangdaoQinhuangdaoHebei ProvinceChina 

出 版 物：《Journal of Geriatric Cardiology》 (老年心脏病学杂志（英文版）)

年 卷 期：2020年第17卷第11期

页      面：659-665页

核心收录：

学科分类：1002[医学-临床医学] 10[医学] 

基　　金：supported by the CAMS Innovation Fund for Medical Sciences (CIFMS, 2016-I2M-1-009) Twelfth Five-Year Planning Project of the Scientific and Technological Department of China (2011BAI11B02) National Natural Science Foundation of China (No 81670415)。 

主　　题：Acute myocardial infarction Clopidogrel Drug interaction Propensity score matching Proton-pump inhibitors 

摘      要：Background Proton pump inhibitors(PPIs) are recommended by the latest guidelines to reduce the risk of bleeding in acute myocardial infarction(AMI) patients treated with dual antiplatelet therapy(DAPT). However, previous pharmacodynamic and clinical studies have reported controversial results on the interaction between PPI and the P2 Y12 inhibitor clopidogrel. We investigated the impact of PPIs use on in-hospital outcomes in AMI patients, aiming to provide a new insight on the value of PPIs. Methods A total of 23,380 consecutive AMI patients who received clopidogrel with or without PPIs in the China Acute Myocardial Infarction(CAMI) registry were analyzed. The primary endpoint was major adverse cardiovascular and cerebrovascular events(MACCE) defined as a composite of in-hospital cardiac death, re-infarction and stroke. Propensity score matching(PSM) was used to control potential baseline confounders. Multivariate logistic regression analysis was performed to evaluate the effect of PPIs use on MACCE and gastrointestinal bleeding(GIB). Results Among the whole AMI population, a large majority received DAPT and 67.5% were co-medicated with PPIs. PPIs use was associated with a decreased risk of MACCE(Before PSM OR: 0.857, 95% CI: 0.742-0.990, P = 0.0359;after PSM OR: 0.862, 95% CI: 0.768-0.949, P = 0.0245) after multivariate adjustment. Patients receiving PPIs also had a lower risk of cardiac death but a higher risk of complicating with stroke. When GIB occurred, an alleviating trend of GIB severity was observed in PPIs group. Conclusions Our study is the first nation-wide large-scale study to show evidence on PPIs use in AMI patients treated with DAPT. We found that PPIs in combination with clopidogrel was associated with decreased risk for MACCE in AMI patients, and it might have a trend to mitigate GIB severity. Therefore, PPIs could become an available choice for AMI patients during hospitalization.