ISSN 1671-5411 CN 11-5329/R

Dear Colleagues,

Journal of Geriatric Cardiology (J Geriatr Cardiol, JGC) will launch a new website and adopt ScholarOne ManuscriptsTM system to manage the submission and peer review process from November 1, 2020. To review and check the status of your manuscripts submitted before November 2020, please visit...

more

Volume 17 Issue 11
Dec.  2020
Turn off MathJax
Article Contents
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, on behalf of China Acute Myocardial In-farction (CAMI) Registry study group. 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. J Geriatr Cardiol 2020; 17(11): 659-665. doi: 10.11909/j.issn.1671-5411.2020.11.008
Citation: 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, on behalf of China Acute Myocardial In-farction (CAMI) Registry study group. 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. J Geriatr Cardiol 2020; 17(11): 659-665. doi: 10.11909/j.issn.1671-5411.2020.11.008

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

doi: 10.11909/j.issn.1671-5411.2020.11.008
More Information
  • Corresponding author:

    Meng-Yue YU, Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China. E-mails: yumy73@163.com (Yu MY)

    Yue-Jin YANG, Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China. E-mails: yangyjfw@126.com (Yang YJ)

  • Received Date: 2020-09-03
  • Accepted Date: 2020-11-05
  • Rev Recd Date: 2020-10-26
  • Available Online: 2020-11-28
  • Publish Date: 2020-11-28
  •  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 P2Y12 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.
  • *The first two authors contributed equally to this work.
  • loading
  • [1]
    Nikolsky E, Stone GW, Kirtane AJ, et al. Gastrointestinal bleeding in patients with acute coronary syndromes: incidence, predictors, and clinical implications: analysis from the ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) trial. J Am Coll Cardiol 2009: 1293-1302.
    [2]
    Valgimigli M, Costa F, Lokhnygina Y, et al. Trade-off of myocardial infarction vs. bleeding types on mortality after acute coronary syndrome: lessons from the Thrombin Receptor Antagonist for Clinical Event Reduction in Acute Coronary Syndrome (TRACER) randomized trial. Eur Heart J 2017; 38: 804-810.
    [3]
    Steg PG, Huber K, Andreotti F, et al. Bleeding in acute coronary syndromes and percutaneous coronary interventions: position paper by the Working Group on Thrombosis of the European Society of Cardiology. Eur Heart J 2011; 32: 1854-1864. doi: 10.1093/eurheartj/ehr204
    [4]
    Valgimigli M, Bueno H, Byrne RA, et al. 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS: The Task Force for dual antiplatelet therapy in coronary artery disease of the European Society of Cardiology (ESC) and of the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 2018; 39: 213-260. doi: 10.1093/eurheartj/ehx419
    [5]
    Mega JL, Close SL, Wiviott SD, et al. Cytochrome p-450 polymorphisms and response to clopidogrel. N Engl J Med 2009; 360: 354-362. doi: 10.1056/NEJMoa0809171
    [6]
    Melloni C, Washam JB, Jones WS, et al. Conflicting results between randomized trials and observational studies on the impact of proton pump inhibitors on cardiovascular events when coadministered with dual antiplatelet therapy: systematic review. Circ Cardiovasc Qual Outcome 2015; 8: 47-55. doi: 10.1161/CIRCOUTCOMES.114.001177
    [7]
    Xu HY, Li W, Yang JG, et al. The China Acute Myocardial Infarction (CAMI) Registry: A national long-term registry- research-education integrated platform for exploring acute myocardial infarction in China. Am Heart J 2016; 175: 193-201. doi: 10.1016/j.ahj.2015.04.014
    [8]
    Thygesen K, Alpert JS, Jaffe AS, et al. Third universal definition of myocardial infarction. Glob Heart 2012; 7: 275-295. doi: 10.1016/j.gheart.2012.08.001
    [9]
    Subherwal S, Bach RG, Chen AY, et al. Baseline risk of major bleeding in non-ST-segment-elevation myocardial infarction: the CRUSADE (Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA Guidelines) Bleeding Score. Circulation 2009; 119: 1873-1882. doi: 10.1161/CIRCULATIONAHA.108.828541
    [10]
    Kim KA, Park PW, Hong SJ, et al. The effect of CYP2C19 polymorphism on the pharmacokinetics and pharmacodynamics of clopidogrel: a possible mechanism for clopidogrel resistance. Clin Pharmacol Ther 2008; 84: 236-242. doi: 10.1038/clpt.2008.20
    [11]
    Parri MS, Gianetti J, Dushpanova A, et al. Pantoprazole significantly interferes with antiplatelet effect of clopidogrel: results of a pilot randomized trial. Int J Cardiol 2013; 167: 2177-2181. doi: 10.1016/j.ijcard.2012.05.080
    [12]
    Jackson LR, Peterson ED, McCoy LA, et al. Impact of Proton Pump Inhibitor Use on the Comparative Effectiveness and Safety of Prasugrel Versus Clopidogrel: Insights From the Treatment With Adenosine Diphosphate Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events After Acute Coronary Syndrome (TRANSLATE-ACS) Study. J Am Heart Assoc 2016; 5: e003824.
    [13]
    Gargiulo G, Costa F, Ariotti S, et al. Impact of proton pump inhibitors on clinical outcomes in patients treated with a 6- or 24-month dual-antiplatelet therapy duration: Insights from the PROlonging Dual-antiplatelet treatment after Grading stent- induced Intimal hyperplasia studY trial. Am Heart J 2016; 174: 95-102. doi: 10.1016/j.ahj.2016.01.015
    [14]
    Weisz G, Smilowitz NR, Kirtane AJ, et al. Proton Pump Inhibitors, Platelet Reactivity, and Cardiovascular Outcomes After Drug-Eluting Stents in Clopidogrel-Treated Patients: The ADAPT- DES Study. Circ Cardiovasc Interv 2015; 8: e001952.
    [15]
    Chandrasekhar J, Bansilal S, Baber U, et al. Mehran, Impact of proton pump inhibitors and dual antiplatelet therapy cessation on outcomes following percutaneous coronary intervention: Results From the PARIS Registry. Catheter Cardiovasc Interv 2017; 89: E217-E225. doi: 10.1002/ccd.26716
    [16]
    Landi SN, Sandler RS, Pate V, et al. No increase in risk of acute myocardial infarction in privately insured adults prescribed proton pump inhibitors vs. histamine-2 receptor antagonists (2002-2014). Gastroenterology 2018; 154: 861-873. doi: 10.1053/j.gastro.2017.10.042
    [17]
    Malhotra K, Katsanos AH, Bilal M, et al. Cerebrovascular outcomes with proton pump inhibitors and thienopyridines: a systematic review and meta-analysis. Stroke 2018; 49: 312-318. doi: 10.1161/STROKEAHA.117.019166
    [18]
    Yi XY, Zhou Q, Wang C, et al. Concomitant use of proton pump inhibitors and clopidogrel is not associated with adverse outcomes after ischemic stroke in chinese population. J Stroke Cerebrovasc Dis 2016; 25: 2859-2867. doi: 10.1016/j.jstrokecerebrovasdis.2016.08.001
    [19]
    Yang GH, Wang Y, Zeng YX, et al. Rapid health transition in China, 1990-2010: findings from the Global Burden of Disease Study 2010. Lancet 2013; 381: 1987-2015. doi: 10.1016/S0140-6736(13)61097-1
    [20]
    Hu S, Cui BJ, Mlynash M, et al. Stroke epidemiology and stroke policies in China from 1980 to 2017: A systematic review and meta-analysis. Int J Stroke 2020; 15: 18-28. doi: 10.1177/1747493019873562
    [21]
    Zhu P, Gao Z, Tang XF, et al. Impact of proton-pump inhibitors on the pharmacodynamic effect and clinical outcomes in patients receiving dual antiplatelet therapy after percutaneous coronary intervention: a propensity score analysis. Chin Med J (Engl) 2017; 130: 2899-2905. doi: 10.4103/0366-6999.220304
    [22]
    Aihara H, Sato A, Takeyasu N, et al. Effect of individual proton pump inhibitors on cardiovascular events in patients treated with clopidogrel following coronary stenting: results from the Ibaraki Cardiac Assessment Study Registry. Catheter Cardiovasc Interv 2012; 80: 556-563. doi: 10.1002/ccd.23327
  • 加载中

Catalog

    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Figures(1)  / Tables(4)

    Article Metrics

    Article views (139) PDF downloads(24) Cited by()
    Proportional views
    Related

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return