Association of the use of proton pump inhibitors with adverse cardiovascular and bleeding outcomes after percutaneous coronary intervention in the Japanese real world clinical practice
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- 作者：Takeshi Kimura (1)
Takeshi Morimoto (2)
Yutaka Furukawa (3)
Yoshihisa Nakagawa (4)
Kazushige Kadota (5)
Masashi Iwabuchi (6)
Satoshi Shizuta (1)
Hiroki Shiomi (1)
Tomohisa Tada (1)
Junichi Tazaki (1)
Yoshihiro Kato (1)
Mamoru Hayano (1)
Mitsuru Abe (7)
Takashi Tamura (8)
Manabu Shirotani (9)
Shinji Miki (10)
Mitsuo Matsuda (11)
Mamoru Takahashi (12)
Katsuhisa Ishii (13)
Masaru Tanaka (14)
Takeshi Aoyama (15)
Osamu Doi (16)
Ryuichi Hattori (15)
Ryozo Tatami (17)
Satoru Suwa (18)
Akinori Takizawa (19)
Yoshiki Takatsu (20)
Masaaki Takahashi (21)
Hiroshi Kato (22)
Teruki Takeda (23)
Jong-Dae Lee (24)
Ryuji Nohara (25)
Chuwa Tei (26)
Minoru Horie (27)
Hirofumi Kambara (16)
Hisayoshi Fujiwara (20)
Kazuaki Mitsudo (5)
Masakiyo Nobuyoshi (6)
Toru Kita (3) - 关键词：Stents ; Angioplasty ; Thrombus
- 刊名：Cardiovascular Intervention and Therapeutics
- 出版年：2011
- 出版时间：September 2011
- 年：2011
- 卷：26
- 期：3
- 页码：222-233
- 全文大小：452KB
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27. Abraham NS, Hlatky MA, Antman EM, Bhatt DL, Bjorkman DJ, Clark CB, et al. ACCF/ACG/AHA 2010 expert consensus document on the concomitant use of proton pump inhibitors and thienopyridines: a focused update of the ACCF/ACG/AHA 2008 expert consensus document on reducing the gastrointestinal risks of antiplatelet therapy and NSAID use. Circulation. 2010;122:2619-3. - 作者单位：Takeshi Kimura (1)
Takeshi Morimoto (2)
Yutaka Furukawa (3)
Yoshihisa Nakagawa (4)
Kazushige Kadota (5)
Masashi Iwabuchi (6)
Satoshi Shizuta (1)
Hiroki Shiomi (1)
Tomohisa Tada (1)
Junichi Tazaki (1)
Yoshihiro Kato (1)
Mamoru Hayano (1)
Mitsuru Abe (7)
Takashi Tamura (8)
Manabu Shirotani (9)
Shinji Miki (10)
Mitsuo Matsuda (11)
Mamoru Takahashi (12)
Katsuhisa Ishii (13)
Masaru Tanaka (14)
Takeshi Aoyama (15)
Osamu Doi (16)
Ryuichi Hattori (15)
Ryozo Tatami (17)
Satoru Suwa (18)
Akinori Takizawa (19)
Yoshiki Takatsu (20)
Masaaki Takahashi (21)
Hiroshi Kato (22)
Teruki Takeda (23)
Jong-Dae Lee (24)
Ryuji Nohara (25)
Chuwa Tei (26)
Minoru Horie (27)
Hirofumi Kambara (16)
Hisayoshi Fujiwara (20)
Kazuaki Mitsudo (5)
Masakiyo Nobuyoshi (6)
Toru Kita (3)
1. Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
2. Center for Medical Education and Clinical Epidemiology Unit, Graduate School of Medicine, Kyoto University, Kyoto, Japan
3. Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
4. Division of Cardiology, Tenri Hospital, Tenri, Japan
5. Division of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
6. Division of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
7. Division of Cardiology, Kyoto Medical Center, Kyoto, Japan
8. Division of Cardiology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
9. Division of Cardiology, Nara Hospital, Kinki University Faculty of Medicine, Ikoma, Japan
10. Division of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan
11. Division of Cardiology, Kishiwada City Hospital, Kishiwada, Japan
12. Division of Cardiology, Shimabara Hospital, Kyoto, Japan
13. Division of Cardiology, Kansai Denryoku Hospital, Osaka, Japan
14. Division of Cardiology, Osaka Red Cross Hospital, Osaka, Japan
15. Division of Cardiology, Shimada Municipal Hospital, Shimada, Japan
16. Division of Cardiology, Shizuoka General Hospital, Shizuoka, Japan
17. Division of Cardiology, Maizuru Kyosai Hospital, Maizuru, Japan
18. Division of Cardiology, Juntendo University Shizuoka Hospital, Shizuoka, Japan
19. Division of Cardiology, Shizuoka City Hospital, Shizuoka, Japan
20. Division of Cardiology, Hyogo Prefectural Amagasaki Hospital, Amagasaki, Japan
21. Division of Cardiology, Hamamatsu Rosai Hospital, Hamamatsu, Japan
22. Division of Cardiology, Nishi-Kobe Medical Center, Kobe, Japan
23. Division of Cardiology, Koto Memorial Hospital, Higashi-ohmi, Japan
24. Division of Cardiology, University of Fukui Hospital, Fukui, Japan
25. Division of Cardiology, Kitano Hospital, Osaka, Japan
26. Department of Cardiovascular, Respiratory and Metabolic Medicine, Graduate School of Medicine, Kagoshima University, Kagoshima, Japan
27. Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science Hospital, Otsu, Japan
文摘
Previous studies have shown inconsistent results regarding the effects of concomitant use of clopidogrel and proton pump inhibitors (PPI) on cardiovascular outcomes. We sought to evaluate the clinical impact of PPI-use in patients treated with thienopyridines after percutaneous coronary intervention (PCI) in a large Japanese observational database. Among 12446 patients discharged alive on thienopyridines (ticlopidine 90.4% and clopidogrel 9.6%), 3223 patients were treated with PPIs and 9223 patients without PPI at the time of hospital discharge. The PPI group included more patients with co-morbidities than the non-PPI group. The adjusted hazard ratio (HR) of PPI-use for a composite of cardiovascular death, myocardial infarction, and stroke was 1.26 (95% confidence interval (CI) 1.09-.47, p?=?0.002). The adjusted HR of PPI-use for bleeding was 1.26 (95% CI 1.05-.52, p?=?0.013). Cardiovascular and bleeding outcomes were not different among the three groups receiving three different types of PPI. The negative effect of PPI on cardiovascular outcome was consistently seen in both drug-eluting stent (DES) [HR 1.31 (95% CI 1.07-.6, p?=?0.0097)] and non-DES strata [HR 1.25 (95% CI: 0.99-.57, p?=?0.057)] (Interaction p?=?0.79) despite the fact that the duration of thienopyridine administration was significantly longer in patients receiving DES. In conclusion, cardiovascular outcomes after PCI were significantly worse in patients with PPI than in patients without PPI in the Japanese real clinical practice. However, the observed poorer cardiovascular outcome in patients receiving PPI was most likely to be related to residual confounding and seemed not causally related to attenuation of antiplatelet effect of thienopyridine through interaction with PPI.