Effect of clopidogrel combined with proton pump inhibitor on prognosis of acute coronary syndrome after percutaneous coronary intervention
Abstract：Objective To explore the effect of clopidogrel combined with proton pump inhibitor(PPI) on prognosis of acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI).Methods Totally 18 077 patients of ACS after PCI in 15 clinical centers from 10 countries (Canada,Brazil,Germany,Poland,Netherlands,Spain,Italy,Greece,China,Japan) from 2013 to 2014 were retrospectively analyzed.The relevance among clopidogrel,PPI and prognosis after PCI was studied.Basic clinical features,disease histories,biochemical criterion,drug use and the incidence of endpoint events were analyzed between groups.Prognosis factors including ages,gender and clinical indexes were analyzed by Cox proportional hazard function model and adjusted by propensity scores to calculate hazard rate (HR) of PPI.Results Based on data from international multi-center BleeMACs registry,2 676 cases were excluded because of the loss of key data;6 461 cases were excluded according to inclusion and exclusion criteria and propensity scores;8 940 cases were finally enrolled and divided into clopidogrel + PPI group(4 814 cases)and clopidogrel group(4 126 cases).The proportion of female,history of hypertension,hyperlipidemia,diabetes,peripheral vascular diseases,acute myocardial infarction,chronic renal insufficiency,peptic ulcer,coronary artery bypass grafting,hemorrhagic diseases,malignant tumor diseases,unstable angina pectoris,non-ST-segment elevation myocardial infarction,cardiac function Killip classifaction≥ grade 2,percutaneous transluminal coronary angioplasty,the use ratio of angiotensin converting enzyme inhibitor/angiotensin receptor antagonist at discharge,age and the level of creatinine on admission in clopidogrel + PPI group were significantly higher than those in clopidogrel group[25.4％ (1 225/4 814) vs 21.0％ (865/4 126),59.9％ (2 882/4 814) vs 49.2％ (2 032/4 126),48.3％ (2 327/4 814) vs 42.7％ (1 762/4 126),26.4％ (1 272/4 814) vs 22.1％ (910/4 126),8.0％ (386/4 814) vs 5.6％ (231/4 126),12.3％(593/4 814) vs 10.6％(436/4 126),2.0％(98/4 814) vs 0.7％ (30/4 126),2.3％(112/4 814) vs 1.0％(42/4 126),3.6％ (172/4 814) vs 2.2％(92/4 126),4.5％ (219/4 814) vs 3.0％ (123/4 126),8.0％ (387/4 814) vs 4.7％ (193/4 126),13.4％ (644/4 814) vs 9.1％ (374/4 126),29.1％ (1 400/4 814) vs 15.9％(656/4 126),14.5％ (699/4 814) vs 11.2％ (462/4 126),56.0％ (2 697/4 814) vs 55.7％ (2 300/4 126),75.5 ％ (3 633/4 814) vs 68.6％ (2 829/4 126),(66 ± 12) years vs (61 ± 13) years,(10 ± 6) mg/L vs (9 ± 4) mg/L] (P ＜ 0.05);the level of hemoglobin on admission and the use rate of 3-blocker at discharge in clopidogrel + PPI group were significantly lower than those in clopidogrel group [(138 ± 19) g/L vs (141 ± 16) g/L,80.6％ (3 880/4 814) vs 83.1％ (3 428/4 126)] (P ＜ 0.05).Before adjustment,the incidence of primary endpoint(all-cause death/recurrent myocardial infarction/ hemorrhage)in clopidogrel + PPI group was significantly higher than that in clopidogrel group(Hazard ratio =1.331,95％ confidence interval:1.161-1.524).After adjustment,the incidence of primary endpoint in clopidogrel + PPI group had no significant difference compared to that in clopidogrel group(Hazard ratio =1.036,95％ confidence interval:0.903-1.189).Conclusion It is reasonable to use clopidogrel in combination with PPI in ACS patients after PCI,especially for patients with high risk of gastrointestinal bleeding.
Keywords：Acute coronary syndromeClopidogrelProton pump inhibitorPrognosis
Publication Date：2017-01-01
Online Publishing Date：2026-09-14(First online date of this platform, not the publication date of the document)
Pages：6( 161-166 )