| Affiliation: | 1. Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, the Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China;2. Vanke School of Public Health, Tsinghua University;3. Department of Gastroenterology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China;4. Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China;5. Division of Cardiology, University of North Carolina, Chapel Hill;6. Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China;7. Department of Cardiology, Peking University First Hospital, Beijing, China;8. Division of Cardiology, Geffen School of Medicine at University of California, Los Angeles;9. International Quality Improvement Department, American Heart Association, Dallas, TX;10. Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, Liaoning, China;1. Division of Vascular and Endovascular Surgery;2. Division of Biomedical Statistics, Mayo Clinic, Rochester, MN. J.J.N. is currently at the Charles George VA Medical Center, Asheville, NC. M.C. is currently at Instituto Vascular, Passo Fundo, Brazil. P.G.R. is currently in the Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN;1. Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN;2. Advisor to residents and Consultant in Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN;1. Stanford Healthcare AI Applied Research Team, Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA;1. Division of Cardiology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul;2. Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul;3. Division of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea;1. Novartis Institutes of Biomedical Research, Cambridge, MA;2. Department of Hematology, Mayo Clinic, Rochester, MN |
| Abstract: | ObjectiveTo evaluate the association between proton pump inhibitor (PPI) use and in-hospital gastrointestinal (GI) bleeding in patients with acute coronary syndrome (ACS) taking dual antiplatelet therapy (DAPT).Patients and MethodsThis study is based on the Improving Care for Cardiovascular Disease in China-ACS project, an ongoing collaborative registry and quality improvement project of the American Heart Association and the Chinese Society of Cardiology. A total of 25,567 patients with ACS taking DAPT from 172 hospitals from July 1, 2017, through December 31, 2018, were included. Multivariable Cox regression and propensity score–matched analyses were used to evaluate the association between PPI use and in-hospital GI bleeding.ResultsOf these patients with ACS, 63.9% (n=16,332) were prescribed PPIs within 24 hours of admission. Patients using PPIs had a higher rate of GI bleeding compared with those not using PPIs (1.0% vs 0.5%; P<.001). In the multivariable Cox regression analysis, early PPI use was associated with a 58% higher risk of GI bleeding (hazard ratio, 1.58; 95% CI, 1.15 to 2.18; P=.005). Further propensity score matching attenuated the association but still showed that patients using PPIs had a higher rate of GI bleeding (0.8% vs 0.6%; P=.04).ConclusionIn China, PPIs are widely used within 24 hours of admission in patients with ACS taking DAPT. An increased risk of GI bleeding is observed in inpatients with early PPI use. Randomized trials on early use of PPIs in patients with ACS receiving DAPT are warranted.Trial Registrationclinicaltrials.gov Identifier: NCT02306616. |
