背景与目的:药理学研究表明,抗血小板药物,尤其是氯吡格雷,与质子泵抑制剂存在着竞争性抑制作用。本研究旨在系统性分析临床中不同质子泵抑制剂与抗血小板药物联用时心血管事件的发生风险。方法:计算机检索Cochrane图书馆、PubMed、EMb...背景与目的:药理学研究表明,抗血小板药物,尤其是氯吡格雷,与质子泵抑制剂存在着竞争性抑制作用。本研究旨在系统性分析临床中不同质子泵抑制剂与抗血小板药物联用时心血管事件的发生风险。方法:计算机检索Cochrane图书馆、PubMed、EMbase、Elsevier、Web of science等数据库,检索时间从2010年1月至2012年9月,对符合纳入标准的文献进行检索并追踪已获文献的参考文献,采用RevMan 5.0软件进行Meta分析。结果:共纳入14篇文献,合计67 131例患者。Meta分析结果显示,使用奥美拉唑有增加心血管事件发生的风险[RR=1.32,95%CI(1.01,1.71)];使用雷贝拉唑有增加心血管事件发生的风险[RR=1.57,95%CI(1.12,2.19)];使用兰索拉唑不增加心血管事件发生风险[RR=1.11,95%CI(0.93,1.32)];使用埃索美拉唑不增加心血管事件发生风险[RR=1.24,95%CI(0.91,1.68)];使用泮托拉唑不增加心血管事件发生风险[RR=1.34,95%CI(0.93,1.92)]。结论:奥美拉唑或雷贝拉唑与抗血小板药物联用时会增加心血管事件发生风险,而泮托拉唑、埃索美拉唑及兰索拉唑与抗血小板药物联用时不会增加心血管事件发生风险。展开更多
Background:The Shexiang Baoxin Pill(MUSKARDIA)has been used for treating coronary artery disease(CAD)and angina for more than 30 years in China.Nevertheless,methodologically sound trials on the use of MUSKARDIA in CAD...Background:The Shexiang Baoxin Pill(MUSKARDIA)has been used for treating coronary artery disease(CAD)and angina for more than 30 years in China.Nevertheless,methodologically sound trials on the use of MUSKARDIA in CAD patients are scarce.The aim of the study is to determine the effects of MUSKARDIA as an add-on to optimal medical therapy(OMT)in patients with stable CAD.Methods:A total of 2674 participants with stable CAD from 97 hospitals in China were randomized 1:1 to a MUSKARDIA or placebo group for 24 months.Both groups received OMT according to local tertiary hospital protocols.The primary outcome was the occurrence of a major adverse cardiovascular event(MACE),defined as a composite of cardiovascular death,non-fatal myocardial infarction(MI),or non-fatal stroke.Secondary outcomes included all-cause mortality,non-fatal MI,non-fatal stroke,hospitalization for unstable angina or heart failure,peripheral revascularization,angina stability and angina frequency.Results:In all,99.7%of the patients were treated with aspirin and 93.0%with statin.After 2 years of treatment,the occurrence of MACEs was reduced by 26.9%in the MUSKARDIA group(MUSKARDIA:1.9%vs.placebo:2.6%;odds ratio=0.80;95%confidence interval:0.45-1.07;P=0.2869).Angina frequency was significantly reduced in the MUSKARDIA group at 18 months(P=0.0362).Other secondary endpoints were similar between the two groups.The rates of adverse events were also similar between the two groups(MUSKARDIA:17.7%vs.placebo:17.4%,P=0.8785).Conclusions:As an add-on to OMT,MUSKARDIA is safe and significantly reduces angina frequency in patients with stable CAD.Moreover,the use of MUSKARDIA is associated with a trend toward reduced MACEs in patients with stable CAD.The results suggest that MUSKARDIA can be used to manage patients with CAD.Trial registration:chictr.org.cn,No.ChiCTR-TRC-12003513.展开更多
Background:The platelet to lymphocyte ratio(PLR)has recently emerged as a potential inflammatory biomarker and has been shown to be significantly associated with atherosclerotic coronary artery disease(CAD).Therefore,...Background:The platelet to lymphocyte ratio(PLR)has recently emerged as a potential inflammatory biomarker and has been shown to be significantly associated with atherosclerotic coronary artery disease(CAD).Therefore,we aimed to explore the association of PLR with in-hospital major adverse cardiovascular events(MACEs)and the severity of CAD assessed by the Gensini score(GS)in patients with acute myocardial infarction(AMI)undergoing coronary angiography.Methods:A total of 502 patients with AMI consecutively treated at the Affiliated Hospital of Qingdao University(Qingdao,China)and underwent coronary angiography from August 2017 to December 2018 were recruited in this study.The demographic,clinical,angiographic characteristics,and laboratory parameters were collected.According to the presence of in-hospital MACEs,the included patients were divided into the MACE group(n=81)and the non-MACE group(n=421).Further,according to tertiles of the GS,the patients were classified into three groups:the low GS group(GS≤32 points,n=173),medium GS group(32 points<GS≤60 points,n=169),and high GS group(60 points<GS≤180 points,n=160).The main statistical methods included Chisquared test,non-parametric Mann-Whitney U test,Kruskal-Wallis H test,logistic regression,and receiver operating characteristic curves.Results:The PLR in the MACE group was significantly higher than that in the non-MACE group(179.43[132.84,239.74]vs.116.11[87.98,145.45],Z=-8.109,P<0.001).Further,there were significant differences in PLR among the tertiles of GS(110.05[84.57,139.06]vs.119.78[98.44,157.98]vs.140.00[102.27,191.83],H=19.524,P<0.001).PLR was demonstrated to be an independent risk factor of in-hospital MACEs(odds ratio[OR]:1.012,95%confidential interval[CI]:1.006-1.018,P<0.001)and severe CAD assessed by the GS(OR:1.004,95%CI:1.002-1.009,P=0.042).The cutoff value of PLR for predicting the development of in-hospital MACEs was 151.28 with a sensitivity of 66.7%and a specificity of 78.1%(area under the curve[AUC]:0.786,95%CI:0.730-0.842,P<0.001),and 展开更多
文摘背景与目的:药理学研究表明,抗血小板药物,尤其是氯吡格雷,与质子泵抑制剂存在着竞争性抑制作用。本研究旨在系统性分析临床中不同质子泵抑制剂与抗血小板药物联用时心血管事件的发生风险。方法:计算机检索Cochrane图书馆、PubMed、EMbase、Elsevier、Web of science等数据库,检索时间从2010年1月至2012年9月,对符合纳入标准的文献进行检索并追踪已获文献的参考文献,采用RevMan 5.0软件进行Meta分析。结果:共纳入14篇文献,合计67 131例患者。Meta分析结果显示,使用奥美拉唑有增加心血管事件发生的风险[RR=1.32,95%CI(1.01,1.71)];使用雷贝拉唑有增加心血管事件发生的风险[RR=1.57,95%CI(1.12,2.19)];使用兰索拉唑不增加心血管事件发生风险[RR=1.11,95%CI(0.93,1.32)];使用埃索美拉唑不增加心血管事件发生风险[RR=1.24,95%CI(0.91,1.68)];使用泮托拉唑不增加心血管事件发生风险[RR=1.34,95%CI(0.93,1.92)]。结论:奥美拉唑或雷贝拉唑与抗血小板药物联用时会增加心血管事件发生风险,而泮托拉唑、埃索美拉唑及兰索拉唑与抗血小板药物联用时不会增加心血管事件发生风险。
基金This study was funded by the Shanghai Science and Technology Committee and Shanghai Hutchison Pharmaceuticals Company.
文摘Background:The Shexiang Baoxin Pill(MUSKARDIA)has been used for treating coronary artery disease(CAD)and angina for more than 30 years in China.Nevertheless,methodologically sound trials on the use of MUSKARDIA in CAD patients are scarce.The aim of the study is to determine the effects of MUSKARDIA as an add-on to optimal medical therapy(OMT)in patients with stable CAD.Methods:A total of 2674 participants with stable CAD from 97 hospitals in China were randomized 1:1 to a MUSKARDIA or placebo group for 24 months.Both groups received OMT according to local tertiary hospital protocols.The primary outcome was the occurrence of a major adverse cardiovascular event(MACE),defined as a composite of cardiovascular death,non-fatal myocardial infarction(MI),or non-fatal stroke.Secondary outcomes included all-cause mortality,non-fatal MI,non-fatal stroke,hospitalization for unstable angina or heart failure,peripheral revascularization,angina stability and angina frequency.Results:In all,99.7%of the patients were treated with aspirin and 93.0%with statin.After 2 years of treatment,the occurrence of MACEs was reduced by 26.9%in the MUSKARDIA group(MUSKARDIA:1.9%vs.placebo:2.6%;odds ratio=0.80;95%confidence interval:0.45-1.07;P=0.2869).Angina frequency was significantly reduced in the MUSKARDIA group at 18 months(P=0.0362).Other secondary endpoints were similar between the two groups.The rates of adverse events were also similar between the two groups(MUSKARDIA:17.7%vs.placebo:17.4%,P=0.8785).Conclusions:As an add-on to OMT,MUSKARDIA is safe and significantly reduces angina frequency in patients with stable CAD.Moreover,the use of MUSKARDIA is associated with a trend toward reduced MACEs in patients with stable CAD.The results suggest that MUSKARDIA can be used to manage patients with CAD.Trial registration:chictr.org.cn,No.ChiCTR-TRC-12003513.
文摘Background:The platelet to lymphocyte ratio(PLR)has recently emerged as a potential inflammatory biomarker and has been shown to be significantly associated with atherosclerotic coronary artery disease(CAD).Therefore,we aimed to explore the association of PLR with in-hospital major adverse cardiovascular events(MACEs)and the severity of CAD assessed by the Gensini score(GS)in patients with acute myocardial infarction(AMI)undergoing coronary angiography.Methods:A total of 502 patients with AMI consecutively treated at the Affiliated Hospital of Qingdao University(Qingdao,China)and underwent coronary angiography from August 2017 to December 2018 were recruited in this study.The demographic,clinical,angiographic characteristics,and laboratory parameters were collected.According to the presence of in-hospital MACEs,the included patients were divided into the MACE group(n=81)and the non-MACE group(n=421).Further,according to tertiles of the GS,the patients were classified into three groups:the low GS group(GS≤32 points,n=173),medium GS group(32 points<GS≤60 points,n=169),and high GS group(60 points<GS≤180 points,n=160).The main statistical methods included Chisquared test,non-parametric Mann-Whitney U test,Kruskal-Wallis H test,logistic regression,and receiver operating characteristic curves.Results:The PLR in the MACE group was significantly higher than that in the non-MACE group(179.43[132.84,239.74]vs.116.11[87.98,145.45],Z=-8.109,P<0.001).Further,there were significant differences in PLR among the tertiles of GS(110.05[84.57,139.06]vs.119.78[98.44,157.98]vs.140.00[102.27,191.83],H=19.524,P<0.001).PLR was demonstrated to be an independent risk factor of in-hospital MACEs(odds ratio[OR]:1.012,95%confidential interval[CI]:1.006-1.018,P<0.001)and severe CAD assessed by the GS(OR:1.004,95%CI:1.002-1.009,P=0.042).The cutoff value of PLR for predicting the development of in-hospital MACEs was 151.28 with a sensitivity of 66.7%and a specificity of 78.1%(area under the curve[AUC]:0.786,95%CI:0.730-0.842,P<0.001),and
