不同质子泵抑制剂对急性心肌梗死患者直接经皮冠状动脉介入治疗的影响

Effect of proton pump inhibitors on outcomes of direct percutaneous coronary intervention in acute myocardial infarction patients

目的探讨不同机制的质子泵抑制剂对急性心肌梗死患者直接PCI术后临床效果的影响。方法选择在北京安贞医院抢救中心实施直接PCI、术前术后给予氯吡格雷联合阿司匹林抗血小板治疗的患者354例。随机分为奥美拉唑组(116例)、泮托拉唑组(121例),2组术前分别开始静脉滴注40 mg/d,7 d后持续口服1年(20 mg/d),对照组(117例)未用质子泵抑制剂。观察3组主要不良心血管事件发生率和出血并发症发生情况。结果 3组临床基本资料、冠状动脉造影及PCI比较差异无统计学意义,心源性死亡、非致死性心肌梗死、靶血管血运重建、支架内血栓的发生率奥美拉唑组分别为1.7%、3.4%、9.5%、1.7%,泮托拉唑组分别为1.7%、5.0%、10.7%、2.5%,对照组分别为0.9%、3.4%、12.0%、1.7%。3组主要不良心血管事件发生率相近(P>0.05)。总出血事件发生率与对照组(9.4%)比较,奥美拉唑组(2.6%)和泮托拉唑组(3.3%)明显减少(P<0.01),但奥美拉唑组与泮托拉唑组比较,总出血事件发生率差异无统计学意义(P>0.05)。结论奥美拉唑和泮托拉唑的作用相近,不降低冠状动脉支架置入术后氯吡格雷联合阿司匹林治疗对心血管事件的效果,同时可显著降低出血事件的发生率。

Objective To study the effect of proton pump inhibitors （PPI） on outcomes of direct PCI in AMI patients. Methods A total of 354 AMI patients after treated with clopidogrel（75 mg/ d） and aspirin（100 mg/d） before and after PCI were randomly divided into omeprazole group（n= 116 ）, pantoprazole group （n = 121 ） and control group （n = 117） ）. Patients in omeprazole and panto- prazole groups received continuous intravenous infusion of omeprazole （40 rag/d） and panto- prazole（40 rag/d）,respectively, for 7 d followed by oral omeprazole（20 rag/d） for 1 year before PCI, and those in control group did not receive any PPI. The incidence of major adverse cardiac events（MACE） and hemorrhage was observed in 3 groups. Results The incidence o~ cardiac death,non-lethal MI,TVR,and SAT was 1.7%,3.4%,9.5%, 1.7% respectively in omeprazole group,1.7%,5.0%,10.7%,2.5% respectively in pantoprazole group, and 0. 9% ,3. 4% ,12. 0% , 1.7% respectively in control group（P^0.05）. The total incidence of hemorrhage was significant- ly lower in omeprazole and pantoprazole groups than in control group（2.6% ,3.3% vs 9.4% ,P~ 0.01）. However,no significant difference was found in the total incidence of hemorrhage between omeprazole and pantoprazole groups（P^0.05）. Conclusion Omeprazole and pantoprazole exert a similar effect on MACE. Their combination has no effect on MACE but can significantly reduce the incidence of hemorrhagic events after coronary stent implantation.