CAJ | 학술논문

目的探讨经皮冠脉介入术(PCI)前非急性冠脉综合症(非ACS)患者既往胃镜检查对PCI术后综合评估联用质子泵抑制剂(PPIs)的风险和获益的重要意义.方法回顾性分析673例行PCI术放置冠脉支架的非ACS患者,先将其分为PPIs联用组和未联用组,然后根据与上消化道不良事件密切相关的危险因素再分高、中、低危亚组,分别比较各组心血管和上消化道不良事件发生率的差别以及既往胃镜检查情况.结果 PCI术前5年内仅12.2％(82/673)的患者曾行胃镜检查,消化性溃疡的总体检出率为32.9％(27/82),PPIs联用组占55.6％(15/27).PPIs联用组患者的心血管不良事件发生率显著高于未联用组(22.6％比8.9％,P＜0.01),其中以消化道高危患者(16.4％,24/146)的心血管不良事件发生率最高(41.7％,10/24),但其上消化道不良事件发生率最低(4.2％,1/24).90.5％ (344/380)的中危患者是年龄≥65岁且联用NSAIDs等药物者,其在PCI术前5年内行胃镜检查的比例显著低于既往有上消化道病史且联用NSAIDs等药物者(PPIs联用组:14.1％比54.5％,P＜0.01；未联用组:7.5％比28.0％,P＜0.01),在PPIs联用组前者心血管不良事件发生率显著高于后者(20.5％比9.1％,P＜0.01),但两者在PCI术后1年内上消化道不良事件的发生率相近(9.0％比9.1％,P ＞0.05).结论 PCI术前既往胃镜检查可提供上消化道基础疾病信息,有助于PCI术后合理应用PPIs,减少心血管不良事件的发生.年龄≥65岁且联用NSAIDs等药物的中危患者是需重点关注的人群.
목적 탐토경피관맥개입술(PCI)전비급성관맥종합증(비ACS)환자기왕위경검사대PCI술후종합평고련용질자빙억제제(PPIs)적풍험화획익적중요의의.방법 회고성분석673례행PCI술방치관맥지가적비ACS환자,선장기분위PPIs련용조화미련용조,연후근거여상소화도불량사건밀절상관적위험인소재분고、중、저위아조,분별비교각조심혈관화상소화도불량사건발생솔적차별이급기왕위경검사정황.결과 PCI술전5년내부12.2％(82/673)적환자증행위경검사,소화성궤양적총체검출솔위32.9％(27/82),PPIs련용조점55.6％(15/27).PPIs련용조환자적심혈관불량사건발생솔현저고우미련용조(22.6％비8.9％,P＜0.01),기중이소화도고위환자(16.4％,24/146)적심혈관불량사건발생솔최고(41.7％,10/24),단기상소화도불량사건발생솔최저(4.2％,1/24).90.5％ (344/380)적중위환자시년령≥65세차련용NSAIDs등약물자,기재PCI술전5년내행위경검사적비례현저저우기왕유상소화도병사차련용NSAIDs등약물자(PPIs련용조:14.1％비54.5％,P＜0.01；미련용조:7.5％비28.0％,P＜0.01),재PPIs련용조전자심혈관불량사건발생솔현저고우후자(20.5％비9.1％,P＜0.01),단량자재PCI술후1년내상소화도불량사건적발생솔상근(9.0％비9.1％,P ＞0.05).결론 PCI술전기왕위경검사가제공상소화도기출질병신식,유조우PCI술후합리응용PPIs,감소심혈관불량사건적발생.년령≥65세차련용NSAIDs등약물적중위환자시수중점관주적인군.
Objective To evaluate previous gastroscopy before percutaneous coronary intervention (PCI) for the risks and benefits of concomitant use of proton pump inhibitors (PPIs) after PCI in patients with non-acute coronary syndrome (non-ACS).Methods The data of 673 non-ACS patients who underwent PCI with stenting were retrospectively analyzed.They were divided into concomitant use of PPIs group and non-PPIs group,then subdivided into high-,moderate-and low-risk groups according to risk factors associated with adverse upper gastrointestinal (GI) events.The incidences of adverse cardiovascular events and adverse upper GI events were compared among groups.Findings of previous gastroscopy were also included.Results Only 82 patients (12.2％) underwent gastroscopy within 5 years before PCI,of whom,27 (32.9％) were diagnosed as having peptic ulcer,and 55.6％ (15/27) of whom were in concomitant use of PPIs.Compared with the non-PPIs group,the rate of adverse cardiovascular events in the concomitant use of PPIs group was significantly higher (22.6％ vs.8.9％,P ＜0.01),and the highest rate (41.7％) was in the high-risk group.However,the corresponding rate of adverse upper GI events was the lowest (4.2％).In the moderate-risk group,90.5 ％ (344/380) of patients were older than 65 years with concomitant use of NSAIDs.The rate of gastroscopy within 5 years before PCI in these patients was remarkably lower than that in patients who had the history of upper GI disease with concomitant use of NSAIDs (concomitant use of PPIs group 14.1％ vs.54.5％ ; non-PPIs group 7.5％ vs.28.0％ ; P ＜ 0.01).In the concomitant use of PPIs group,the rate of adverse cardiovascular events in the former was notably higher than that in the latter (20.5％ vs.9.1％,P ＜0.01),but the rate of adverse upper GI events within 1 year after PCI were similar (9.0％ vs.9.1％).Conclusion Previous gastroscopy before PCI could provide the baseline information of upper GI disease,which may be helpful for the evaluation of concomitant use of PPIs after PCI so as to decrease the incidence of adverse cardiovascular events.Special attention should be paid to those patients older than 65 years in the moderate-risk group and concomitant use of NSAIDs.