质子泵抑制剂与氯吡格雷联用对老年人心血管事件风险分析

摘要

Objective To assess the cardiovascular risks of concomitant use of proton-pump inhibitors (PPIs) and clopidogrel in elderly patients with acute coronary syndrome (ACS). Methods We collected ACS patients taking clopidogel after discharge from Huashan Hospital from June 2007 to May 2010. All cases were assigned to case group with PPIs and control group without PPIs. The primary end points were the major adverse cardiac events (MACE). The second end points were all-cause mortality, myocardial infarction, rehospitalization for ACS, cardiac death and target vessel revas-cularization. We assessed the cardiovascular risks of concomitant use of clopidogrel and PPIs. Results There were not significant difference between the case group and the control group in the incidence of major adverse cardiac events (36.7% vs. 48.3%), all-cause mortality (4.1% vs. 16.7%), rehospitalization for ACS (32.7% vs. 38.3%), myocardial infarction (8.2% vs. 20.0%), cardiac death (2.0% vs. 6.7%), target vessel revascularization (4.1% vs. 5.0%) (P>0.05). Through multifactor adjusted, concomitant use of clopidogrel and PPIs had no association with MACE (AHR 1.10, 95% CI; 0.56-2.19), all-cause mortality (AHR0.49, 95%CI: 0.07-3.46), rehospitalization for ACS (AHR 1.28, 95%CI: 0.62-2.65), myocardialinfarction (AHR 0.59, 95%CI: 0.16-2.15), cardiac death (AHR 0.39, 95%CI: 0.04-3.85), target vesselrevascularization (AHR 1.23, 95%CI: 0.17-8.70). Among PPIs, Omeprazole had no cardiovascular risks. Conclusion Co-administration of PPIs and clopidogrel may do not increase the cardiovascular risks in elderly with ACS.%目的 评估质子泵抑制剂与氯吡格雷联用对老年急性冠脉综合征患者的心血管事件风险.方法 收集2007年6月至2010年5月复旦大学附属华山医院老年科住院的急性冠脉综合征(ACS)患者,按出院后是否服用质子泵抑制剂(PPIs)分为单用氯吡格雷组和氯吡格雷联用PPIs组,观察两组患者主要终点(主要不良心血管事件MACE)及次要终点(全因死亡、ACS再入院、心肌梗死、心源性死亡、血运重建)的发生率,评估氯吡格雷合用PPIs的心血管事件风险.结果 与单用氯吡格雷组相比,氯吡格雷与PPIs联用组中MACE发生率(36.7％ vs 48.3％),全因死亡(4.1％ vs 16.7％)、ACS再入院(32.7％ vs 38.3％)、心肌梗死(8.2％ vs 20.0％)、心源性死亡(2.0％ vs 6.7％)、血运重建(4.1％ vs 5.0％)发生率无显著差异(P＞0.05).采用多因素校正后,联用PPIs与MACE发生风险无关(AHR=1.10,95 ％CI:0.56-2.19)；与次要终点全因死亡(AHR=0.49,95％CI:0.07-3.46)、ACS再入院(AHR=1.28,95％CI:0.62-2.65)、心肌梗死(AHR=0.59,95％ CI:0.16-2.15)、心源性死亡(AHR=0.39,95％CI:0.04-3.85)、血运重建(AHR=1.23,95％ CI:0.17-8.70)发生风险无关.在不同PPIs中,奥美拉唑与心血管风险无关.结论 在氯吡格雷抗血小板治疗的基础上联用质子泵抑制剂可能不会增加老年ACS患者心血管不良事件的风险.