| Objective:Atrial fibrillation and acute coronary syndrome patients need antithrombotic therapy.The use of antiplatelets and anticoagulants could increase the risk of bleeding.Antithrombotic therapy for acute coronary syndrome(ACS)with atrial fibrillation(AF)among higher risk older patients treated with percutaneous coronary intervention(PCI)remains controversial.Proton pump inhibitors(PPIs)are widely used to prevent the gastrointestinal bleeding events.The aim of our study is to evaluate the effects of PPI on MACCEs events and gastrointestinal bleeding events in acute coronary syndrome patients with atrial fibrillation and undergoing percutaneous coronary intervention with stentPart one The antithrombotic therapy strategy among older patients with acute coronary syndrome and atrial fibrillationMethod:By retrieval the electronic medical records of 12 hospitals in Beijing.Among the patients subjected with the diagnosis of AF and PCI aged onto 75,we identified patients from January 1,2010 to January 1,2015.The exclusion criterion was patients with rheumatic heart disease,mechanical heart valves,peripheral stent,pregnancy,malignant tumor.A total of 470 patients were enrolled and mean age was 78.70±3.32,291 were male(61.91%)and 179 were female(38.09%).Patients were divided in three groups according to their drug use:Triple therapy group,DAPT group and single antiplete therapy group.Compare their endpoints(all-caused death,non-fatal myocardial infarction,stent thrombosis,TVR and stoke events)and bleeding events.Categorical variables are described as percentage and continuous variables are expressed as standard deviations.We used t-test to examine the difference between the two groups and chi-square test to examine the association between two groups(with PPIs and without PPIs).P-value<0.05 was considerate as significant.Result:Among 470 patients,17(3.62%)were discharged on triple therapy.The average medication time was 5.41±3.59 day.450(95.74%)were discharged on DAPT.The average medication was 12.15 ±2.44 day.Relative to DAPT,patients on triple therapy had a similar risk of MACCEs events,stoke events and death events.Patients’ HAS-BLED score ≥3 were all use DAPT.Use Log-rank KM curve to examine the difference between DAPT and triple therapy group,there has no difference in MACCEs events and death events.But the bleeding events of triple therapy were higher than DAPT.Conclusion:1.The use proportion of triple therapy in elder people are very low.2.DAPT is still the main treatment prescription in Beijing.3.Compared with DAPT,there was no difference in mortality risk and MACCEs event risk in triple therapy group.But the bleeding events increased in triple therapy group.Part twoThe retrospective study of the influence of PPI use on clinical outcome in acute coronary syndrome patients with non-valvular atrial fibrillation and undergoing percutaneous coronary intervention with stentObjective:Atrial fibrillation and acute coronary syndrome patients need antithrombotic therapy,and the use of antiplatelets and anticoagulants could increase the risk of bleeding.Antithrombotic therapy for acute myocardial infarction(AMI)with atrial fibrillation(AF)among higher risk older patients treated with percutaneous coronary intervention(PCI)remains unclear.Proton pump inhibitors(PPIs)are widely used to prevent the bleeding events.The aim of our study is to evaluate the effects of PPI on MACCEs events and bleeding events in in acute coronary syndrome patients with atrial fibrillation and undergoing percutaneous coronary intervention with stentMethod:By retrieval the electronic medical records of 12 hospitals in Beijing,all of patients were enrolled in the study.Among the patients subjected with the diagnosis of AF and PCI,we identified patients from January 1,2010 to January 1,2015.The exclusion criterion was patients with rheumatic heart disease,mechanical heart valves,peripheral stent,pregnancy,malignant tumor or age below 18 years.A total of 1967 patients were enrolled.Patients were divided in two groups according to their drug use:with PPIs and without PPIs.Compare their endpoints(all-caused death,non-fatal myocardial infarction,stent thrombosis,TVR and stoke events)and bleeding events.Categorical variables are described as percentage and continuous variables are expressed as standard deviations.We used t-test to examine the difference between the two groups and chi-square test to examine the association between two groups(with PPIs and without PPIs).P-value<0.05 was considerate as significant.Result:About 488(24.8%)patients used the PPIs,mean age was 66.33±9.75.Non PPI group has 1479(75.2)patients and mean age was 66.79±9.72.Bleeding events had occurred in 31(6.35%)vs 99(6.69%).There was no significant difference in the incidence of bleeding events(P=0.81>0.05).According to the HAS-BLED score,we concluded that the use of PPI could decrease the gastrointestinal bleeding events in high bleeding risk group(p=0.024<0.05).There is no significant difference in gastrointestinal bleeding events in low bleeding risk group(p=0.498>0.05).Conclusion:1.The use of PPIs could decrease the gastrointestinal bleeding events in high bleeding risk group.2.The use of PPIs could not increase the risk of MACCEs events and stoke events in patients use clopidogrel.PPIs could not impair the effect of clopidogrel... |
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