经皮冠状动脉介入治疗术后氯吡格雷与奥美拉唑联合应用不良临床结局的观察

Observation of adverse clinical outcomes with concomitant use of clopidogrel and proton pump inhibitorswith percutaneous coronary intervention

目的观察经皮冠状动脉介入（PCI）治疗后患者同时给予氯吡格雷和质子泵抑制剂（PPI）奥美拉唑的不良临床结局。方法回顾性分析2006年5月至2007年10月在我院行PCI治疗后的249例患者的病历资料。所有患者术后均给予氯吡格雷抗血小板治疗，氯吡格雷组（n=192）口服氯吡格雷片75mg／d，氯吡格雷联合奥美拉唑组（n=57）口服氯吡格雷片75mg／d，奥美拉唑胶囊40mg／d，2组疗程均为30d。观察首要指标为主要不良心血管事件（MACE），次要指标包括死亡、心肌梗死、靶血管再栓塞。结果在3年随访期内，氯吡格雷组患者MACE发生率为17．2％（33／192），氯吡格雷联合奥美拉唑组患者MACE发生率为26．3％（15／57），2组MACE发生率差异有统计学意义（P〈0．05）；2组患者的病死率、靶病变血运重建及靶血管再栓塞率差异均无统计学意义（均P〉0．05）。结论氯吡格雷联合PPI应用于PCI术后患者具有较高的MACE风险，PPI可能会减弱氯吡格雷抗血小板凝聚的优势，仍需要前瞻性随机研究提供两种药物相互作用的确切证据。

Objective To observe the incidence of cardiovascular events in patients who are treated with percutaneous coronary intervention （PCI） combined with clopidogrel and omeprazole. Methods The clinical records of 249 patients with PCI were reviewed from May 2006 to October 2007. Clopidogrel and/or omeprazole were used as anti-platelet treatment, and the course of treatment was 30 days. The primary observation outcome was a major adverse cardiovascular~ event （MACE） which was defined as a composite of death, myocardial infarction and target vessel failure. Results ＇ During a mean follow-up period of 36 months, patients discharged with concomitant clopidogrel-PPI therapy had a MACE rate of 26. 3% （15/57） and 17.2% （33/192） in the clopidogrel alone group （P 〈 0. 05）. Conclusions Concomitant use of clopidogrel and omeprazole in post-PCI patients is associated with a higher risk of MACE. Omeprazole may attenuate clopidogrel＇s beneficial antiplatelet effect which is crucial after PCI. Prospective randomized studies are warranted to provide definitive evidence for this interaction.