P2Y12受体抑制剂联合质子泵抑制剂对急性冠脉综合征患者缺血事件影响的临床分析  

Impact of concomitant use of P2Y12 inhibitors and proton pump inhibitors on ischemia events in patients with acute coronary syndrome in real world

作　　者：冯斯婷[1] 严妍[1] 范婧尧 王晓[1] 郑文[1] 聂绍平[1] Sergio Raposeiras-Roubin Emad Abu-Assi Jose P Simao Henriques Fabrizio D' Ascenzo Jorge Saucedo Jose R Conzalez-Juanatey Stephen B Wilton Wouter J Kikkert Ivan Nunez-Gil Albert Ariza-Sole Dimitrios Alexopoulos Christoph Liebetrau Tetsuma Kawaji Claudio Moretti Zenon Huczek Toshiharu Fujii Luis C Correia Masa-aki Kawashiri Sasko Kedev 

机构地区：[1]首都医科大学附属北京安贞医院急诊危重症中心,100029 [2]University Hospital Alvaro Cunqueiro, Vigo, Spain [3]Academic Medical Center, Amsterdam, the Netherlands [4]Dipartimento di Scienze Mediche,Divisione di Cardiologia, Citta della Salute e della Scienza, Turin, Italy [5]North Shore University Hospital, Chicago, USA [6]University Clinical Hospital of Santiago de Compostela, Santiago de compostela, Spain [7]Libin Cardiovascular Institute of Alberta, Calgary, Canada [8]San Carlos Hospital, Madrid, Spain [9]Bellvitge University Hospital, Barcelona, Spain [10]University Patras Hospital, Athens, Greece [11]Kerckhoff Heart and Thorax Center,Frankfurt, Germany [12]Graduate School of Medicine, Kyoto University, Kyoto, Japan [13]University Clinical Hospital, Warsaw, Poland [14]Hospital Sao Rafael, Salvador, Brazil [15]Kanazawa University Graduate School of Medicine, Kanazawa, Japan [16]University Clinic of Cardiology, Skopje, Macedonia

出　　处：《中华医学杂志》2016年第33期2611-2615,共5页National Medical Journal of China

基　　金：国家高技术研究发展计划（863计划）重大项目心血管疾病大数据平台的构建和应用研究（2015AA020102）

摘　　要：目的本研究旨在分析P2Y12受体抑制剂联合质子泵抑制剂（PPI）治疗对经皮冠状动脉介入（PCI）术后的急性冠脉综合征患者缺血事件的影响。方法基于国际多中心回顾性注册登记研究，纳入2003至2014年因急性冠脉综合征人院行PCI术的患者，分为PPI组及非PPI组并随访1年，主要临床终点为全因死亡／再发心肌梗死的复合终点。根据P2Y12受体抑制剂种类，将入组患者分为氯吡格雷组及替格瑞洛组，并比较不同药物与PPI联用发生临床终点事件的风险。结果研究入选9429例患者，PPI组占54．8％，具有更多高危因素。Cox回归结果提示PPI组较非PPI组全因死亡／再发心肌梗死复合事件的发生差异无统计学意义（HR1．00，95％CI 0．86—1．18）。根据P2Y12抑制剂种类不同分为氯吡格雷组和替格瑞洛组，不同P2Y12受体抑制剂联用PPI较未联用PPI患者的临床终点无差异，联用PPI的氯吡格雷组与替格瑞洛组的临床终点差异也无统计学意义。结论急性冠脉综合征患者PPI与P2Y12受体抑制剂联用不增加全因死亡和再发心肌梗死风险，尤其PPI联用氯吡格雷在患者的缺血事件上与替格瑞洛比较差异无统计学意义。Objective The study aimed to analyze the impact of concomitant administration of P2Y12 inhibitors and PPIs on ischemia events in patients with acute coronary syndrome （ACS） after percutaneous coronary intervention （PCI）. Methods We retrospectively analyzed data from a international, multi-center registry between 2003 and 2014 in patients with ACS after PCI, grouped the cohort into patients receiving PPIs or no PPIs and assessed 1-year clinical endpoint （all-cause death/re- infarction）. Meanwhile, we grouped the cohort into patients receiving clopidogrel or ticagrelor, and compared the impact of concomitant administration of PPIs and clopidogrel or ticagrelor on 1-year clinical endpoint. Results Of 9 429 patients in the final cohort, 54. 8% （n = 5 165 ） was prescribed a PPI at discharge. Patients receiving a PPI were more likely to have comorbidities. No association was observed between PPI use and the clinical endpoint （ HR 1.00, 95% CI 0. 86 - 1.18 ）. Meanwhile, no association was found between PPI use and the clinical endpoint in patients receiving either clopidogrel or ticagrelor. And the clinical endpoint in patients administrated of clopidogrel and PPIs had no difference with that of ticagrelor and PPIs. Conclusions In patients with ACS following PCI, increased risk of ischemia event was not found in the concomitant use of PPIs and P2Y12 inhibitors, and especially, compared with ticagrelor, clopidogrel was found no association with ischemia events when concomitant administrated with PPIs.

关 键 词：急性冠脉综合征 氯吡格雷 质子泵抑制剂 患者结局评价 替格瑞洛 

分 类 号：R541.4[医药卫生—心血管疾病]