A Clinical Research About The Effects Of Clopidogrel With Proton Pump Inhibitor Inpatients With Acute Coronary Syndrome

Objective:Observing the incidence of major adverse cardiac events and gastrointestinal bleeding in ACS in-patients applied with clopidogrel and PPI to discuss the necessity and safety in using PPI. Use CRUSADE scoring to rank bleeding risk and to identify PPI beneficial population. Compare the effectiveness and safety in patients applied with different PPI. To study the influence on combined the PPI with clopidogrel in ACS, as to provide guide for drug choosing to prevent gastrointestinal bleeding.Method:In the single-centered retrospective study,l,358 ACS in-patients from TEDA International cardiovascular hospital were involved during 1th Jen 2006 to 20th Feb 2011.All patients received antiplatelet agents aspirin and clopidogrel and were randomized into 3 groups none PPI utilized group (group1),omeprazole combined group(group2) and esomeprazole combined group (group3).Anticoagulants, nitrate esters,βreceptor inhibitor, ACEI or ARB and statins were given in all 3 groups.1. Compare the incidence of major adverse cardiac events, and gastrointestinal bleeding; compare the results which have significant differences as routine.2. Ranking patients in each group to 5 subgroups:extremely high risk group, high risk group,mediate high risk group, low risk group, extremely low risk group according to the CRUSADE bleeding risk scoring, compare incidence of major adverse cardiac events and gastrointestinal bleeding of the subgroups in three groups, compare the results which have significant differences as routine.Results:1. Incidence of major adverse cardiac events in group 1, were 3.5%, 6.3%,4.0%. Differences were not significant among groups(p>0.05). Incidence of gastrointestinal bleeding in groupl, group2 and group3 were 6.9%,1.9%,2.0%. Differences were significant between groups (p<0.05); Differences were significant between group1 and group2 (p<0.0167) and so it is in groupl and group3 (p<0.0167) differences were significant between group2 and group3 (p>0.0167); 2. Compare 5 subgroups according to CRUSADE bleeding risk scoring, no differences were significant among subgroups in each group (p>0.05); there was significant difference within extremely high risk subgroup (p<0.05) and high risk subgroup (p<0.05). In extremely high risk group, group1 and group3 (p<0.0167) were statistically different no significant differences were found between groupl and group2 (p>0.0167), so it is between group 2 and group3. In high subgroup, differences were significant between group1 and group3 (p<0.0167), no differences were found between group1 and group2(p>0.0167), so it is between group2 and group3. In mediate high, low and extremely low subgroups, no differences in gastrointestinal bleeding were found(p>0.05).Conclusion:1. There were no significant influence on the effectiveness of clopidogrel in ACS patients combined with PPI. And the incidence of major adverse cardiac events have not increased.2. PPI can function as a preventer for acute gastrointestinal bleeding for ACS patients, especially significant for the high risk and extremely high risk population according to the CRUSADE bleeding risk scoring.3. No differences in effectiveness and major adverse cardiac events between omeprozole and esomemeprazole in ACS patients.