Impact of proton pump inhibitors on clinical outcomes in patients after acute myocardial infarction: a propensity score analysis from China Acute Myocardial Infarction (CAMI) registry

Wen-Ce Shi; Si-De Gao; Jin-Gang Yang; Xiao-Xue Fan; Lin Ni; Shu-Hong Su; Mei Yu; Hong-Mei Yang; Meng-Yue Yu; Yue-Jin Yang; On Behalf Of China Acute Myocardial In-Farction Cami Registry Study Group

doi:10.11909/j.issn.1671-5411.2020.11.008

Impact of proton pump inhibitors on clinical outcomes in patients after acute myocardial infarction: a propensity score analysis from China Acute Myocardial Infarction (CAMI) registry

J Geriatr Cardiol. 2020 Nov 28;17(11):659-665. doi: 10.11909/j.issn.1671-5411.2020.11.008.

Authors

Affiliations

¹ Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
² Medical Research and Biometrics Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
³ Xinxiang Central Hospital, Xinxiang, Henan Province, China.
⁴ Langfang People's Hospital, Langfang, Hebei Province, China.
⁵ First Hospital of Qinhuangdao, Qinhuangdao, Hebei Province, China.

PMID: 33343644
PMCID: PMC7729183
DOI: 10.11909/j.issn.1671-5411.2020.11.008

Abstract

Background: Proton pump inhibitors (PPIs) are recommended by the latest guidelines to reduce the risk of bleeding in acute myocardial infarction (AMI) patients treated with dual antiplatelet therapy (DAPT). However, previous pharmacodynamic and clinical studies have reported controversial results on the interaction between PPI and the P₂Y₁₂ inhibitor clopidogrel. We investigated the impact of PPIs use on in-hospital outcomes in AMI patients, aiming to provide a new insight on the value of PPIs.

Methods: A total of 23, 380 consecutive AMI patients who received clopidogrel with or without PPIs in the China Acute Myocardial Infarction (CAMI) registry were analyzed. The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE) defined as a composite of in-hospital cardiac death, re-infarction and stroke. Propensity score matching (PSM) was used to control potential baseline confounders. Multivariate logistic regression analysis was performed to evaluate the effect of PPIs use on MACCE and gastrointestinal bleeding (GIB).

Results: Among the whole AMI population, a large majority received DAPT and 67.5% were co-medicated with PPIs. PPIs use was associated with a decreased risk of MACCE (Before PSM OR: 0.857, 95% CI: 0.742-0.990, P = 0.0359; after PSM OR: 0.862, 95% CI: 0.768-0.949, P = 0.0245) after multivariate adjustment. Patients receiving PPIs also had a lower risk of cardiac death but a higher risk of complicating with stroke. When GIB occurred, an alleviating trend of GIB severity was observed in PPIs group.

Conclusions: Our study is the first nation-wide large-scale study to show evidence on PPIs use in AMI patients treated with DAPT. We found that PPIs in combination with clopidogrel was associated with decreased risk for MACCE in AMI patients, and it might have a trend to mitigate GIB severity. Therefore, PPIs could become an available choice for AMI patients during hospitalization.

Keywords: Acute myocardial infarction; Clopidogrel; Drug interaction; Propensity score matching; Proton-pump inhibitors.

Copyright and License information: Journal of Geriatric Cardiology 2020.