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Assessment of Benefit-risk of Short-term Intravenous Proton Pump Inhibitors During Duplex Antiplatelet Treatment for Acute Myocardial Infaerction

Author: LiLiang
Tutor: DengPing
School: Nanhua University
Course: Internal Medicine
Keywords: Clopidogrel Proton Pump Inhibitors Acute Myocardial Infarction Percutaneous Coronary Intervention
CLC: R541.4
Type: Master's thesis
Year: 2011
Downloads: 54
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Abstract

Objective:The study was to assess the benefit-risk of the application of short-term intra-venous proton pump inhibitors (PPIs)to the duplex antiplatelet treatment for patients with acute myocardial infarctionMethods:470 patients, who were hospitalized in Department of Cardiovascular Medicine of Changsha Central Hospital because of acute myocardial infarction from April,2005 to February,2011 and received percutenous transluminal coronary angioplasty (PTCA) combined with intracorpnary stenting (percutenous coronary intervention,PCI) and duplex antiplatelet treatment, were information-gathered and subjected to retrospective analysis, and the usage of anti-peptic ulcer drugs were investigated; among them,214 patients receiving intravenous PPIs were selected as the PPIs group,237 patients not receiving PPIs or H2 receptor blocking agents were selected as the non-PPIs group, and the incidences of nosocomial gastrointestinal events (overt or occult bleeding, ymptomatic gastroduodenal ulcers), the incidences of major adverse cardiovascular events (cardiovascular death, recurrent myocardial infarction and target vessel revasculaziation) and the rehospitalization rates because of acute coronary syndrome withtin 30 days after hospital discharge (rehospitalization rate for short) in the patients of the two groups were compared.Results:1. The differences, resulting from the comparison between the treatment group and the control group in the aspect of clinical baseline characteristicson, usage of cardiovascular drugs, use of gastric mucosal barrier protective drugs, culprit vessel and stent characteristics, were statistically insignificant.2. Compared with the control group, the treatment group had the incidence of gastrointestinal hemorrhage events reduced significantly (6.1% versus 11.4%, P< 0.05), and the difference was statistically significant.3. In contrast to the control group, no statistical difference was found in the incidence of major adverse cardiovascular events (1.7% versus 2.8%, P<0.05) and the rehospitalization rate (3.0% versus 4.7%, P<0.05) in the treatment group.4. In contrast to the control group, the incidence of hospital acquired pneumonia in the treatment group increases (17.3% versus 10.5%, P<0.05), and the difference was statistically significant.Conclusions:1. The short-term intravenous proton pump inhibitors can reduce the incidence of gastrointestinal events caused by duplex antiplatelet treatment after PCI for acute myocardial infarction.2. The combination of the short-term intravenous proton pump inhibitors and clopidogrel does not increase the risk of recent major adverse cardiovascular events and rehospitalization rate of the patients with acute myocardial infarction.3. The short-term intravenous proton pump inhibitors may increase the incidence of hospital acquired pneumonia of the patients after PCI for acute myocardial infarction

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CLC: > Medicine, health > Internal Medicine > Heart, blood vessels ( circulatory ) disease > Heart disease > Coronary arteries ( atherosclerosis ),heart disease (CHD)
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