雷贝拉唑和泮托拉唑对双抗血小板治疗的急性冠脉综合征患者临床结局的影响

Effects of Rabeprazole and Pantoprazole on Clinical Outcomes of Patients with Acute Coronary Syndrome Treated with Dual Antiplatelet

目的:探讨雷贝拉唑和泮托拉唑对双抗血小板治疗的急性冠脉综合征(ACS)患者临床结局的影响。方法:采用回顾性队列研究,纳入2013年1月~2018年9月因ACS收治入院,采用氯吡格雷和阿司匹林双联抗血小板治疗(DAPT),同时联用雷贝拉唑或泮托拉唑的患者4050例。从患者门诊复查记录、再入院记录及电话随访记录中提取资料数据,采用倾向性评分加权的多因素Logistic回归分析,比较联用雷贝拉唑和泮托拉唑对ACS患者12个月内主要心血管不良事件(MACE)、出血事件和胃肠道不良反应发生率的影响。结果:剔除失访及资料不全患者后,雷贝拉唑组和泮托拉唑组患者MACE、出血事件、心源性死亡、再发心肌梗死和再发心绞痛的发生率比较差异均无统计学意义(P>0.05),但雷贝拉唑组患者消化道不良反应发生率显著低于泮托拉唑组(P<0.05)。结论:联用雷贝拉唑和泮托拉唑对接受DAPT的ACS患者心血管不良事件发生风险的影响无明显差异,但联用雷贝拉唑的患者胃肠道不良反应发生率更低。

Objective: To investigate the effects of rabeprazole and pantoprazole on clinical outcomes of patients with acute coronary syndrome( ACS) receiving dual antiplatelet therapy( DAPT). Methods: The retrospective cohort study was conducted in 4050 patients admitted for ACS between January 2013 and September 2018 and received DAPT combined with rabeprazole or pantoprazole.The data was extracted from the records of out-patient review,re-hospitalization and telephone follow-ups. Propensity score weighted multivariate logistic regression analysis was used to compare the impacts of coadministration of rabeprazole and pantoprazole on the occurrence of major adverse cardiovascular events( MACE),bleeding events and adverse gastrointestinal reactions in 12-month followups. Results: After excluding the patients with lost follow-up or incomplete data,no statistically significant difference was found in the occurrence of MACE,bleeding events,cardiovascular death,myocardial infarction and angina pectoris between the two groups( P >0.05). However,compared with that in pantoprazole group,the incidence of adverse gastrointestinal reactions was significantly lower in rabeprazole group( P<0.05). Conclusion: There is no significant difference in the effects of rabeprazole and pantoprazole on the risk of adverse cardiovascular events in patients with ACS receiving DAPT,while the incidence of adverse gastrointestinal reactions of rabeprazole is lower than that of pantoprazole.