000070582 001__ 70582
000070582 005__ 20200221144314.0
000070582 0247_ $$2doi$$a10.1016/j.amjmed.2016.03.042
000070582 0248_ $$2sideral$$a96691
000070582 037__ $$aART-2016-96691
000070582 041__ $$aeng
000070582 100__ $$aVaduganathan, M.
000070582 245__ $$aEfficacy and Safety of Proton-Pump Inhibitors in High-Risk Cardiovascular Subsets of the COGENT Trial
000070582 260__ $$c2016
000070582 5060_ $$aAccess copy available to the general public$$fUnrestricted
000070582 5203_ $$aBackground Proton-pump inhibitors (PPIs) have been demonstrated to reduce rates of gastrointestinal events in patients requiring dual antiplatelet therapy (DAPT). Data are limited regarding the efficacy and safety of PPIs in high-risk cardiovascular subsets after acute coronary syndrome or percutaneous coronary intervention. Methods All patients enrolled in COGENT (Clopidogrel and the Optimization of Gastrointestinal Events Trial) were initiated on DAPT (with aspirin and clopidogrel) for various indications within the prior 21 days. These post hoc analyses of the COGENT trial evaluated the efficacy and safety of omeprazole compared with placebo in subsets of patients requiring DAPT for the 2 most frequent indications: 1) patients undergoing percutaneous coronary intervention (for any indication) within 14 days of randomization (n = 2676; 71.2%); and 2) patients presenting with acute coronary syndrome managed with or without percutaneous coronary intervention (n = 1573; 41.8%). Unadjusted Cox proportional hazards models were used to estimate effect sizes through final follow-up. Results Median follow-up duration was 110 days (interquartile range 55-167). In percutaneous coronary intervention-treated patients, omeprazole significantly reduced rates of composite gastrointestinal events at 180 days (1.2% vs 2.7%; hazard ratio HR] 0.43; 95% confidence interval CI], 0.22-0.85; P =.02) without increasing composite cardiovascular events (5.4% vs 6.3%; HR 1.00; 95% CI, 0.67-1.50; P = 1.00). Similarly, omeprazole lowered risk of the primary gastrointestinal endpoint at 180 days in patients presenting with acute coronary syndrome (1.1% vs 2.7%; HR 0.37; 95% CI, 0.13-1.01; P =.05) without a significant excess in cardiovascular events (5.6% vs 4.5%; HR 1.40; 95% CI, 0.77-2.53; P =.27). Conclusions PPI therapy attenuates gastrointestinal bleeding risk without significant excess in major cardiovascular events in high-risk cardiovascular subsets, regardless of indication for DAPT. Future studies will be needed to clarify optimal gastroprotective strategies for higher-intensity and longer durations of DAPT.
000070582 540__ $$9info:eu-repo/semantics/openAccess$$aby-nc-nd$$uhttp://creativecommons.org/licenses/by-nc-nd/3.0/es/
000070582 590__ $$a5.55$$b2016
000070582 591__ $$aMEDICINE, GENERAL & INTERNAL$$b15 / 154 = 0.097$$c2016$$dQ1$$eT1
000070582 592__ $$a2.007$$b2016
000070582 593__ $$aMedicine (miscellaneous)$$c2016$$dQ1
000070582 655_4 $$ainfo:eu-repo/semantics/article$$vinfo:eu-repo/semantics/acceptedVersion
000070582 700__ $$aCannon, C. P.
000070582 700__ $$aCryer, B. L.
000070582 700__ $$aLiu, Y.
000070582 700__ $$aHsieh, W. -H
000070582 700__ $$aDoros, G.
000070582 700__ $$aCohen, M.
000070582 700__ $$0(orcid)0000-0001-5932-2889$$aLanas, A.$$uUniversidad de Zaragoza
000070582 700__ $$aSchnitzer, T. J.
000070582 700__ $$aShook, T. L.
000070582 700__ $$aLapuerta, P.
000070582 700__ $$aGoldsmith, M. A.
000070582 700__ $$aLaine, L.
000070582 700__ $$aBhatt, D. L.
000070582 7102_ $$11007$$2610$$aUniversidad de Zaragoza$$bDpto. Medicina, Psiqu. y Derm.$$cArea Medicina
000070582 773__ $$g129, 9 (2016), 1002-1005$$pAm. j. med.$$tAMERICAN JOURNAL OF MEDICINE$$x0002-9343
000070582 8564_ $$s102419$$uhttps://zaguan.unizar.es/record/70582/files/texto_completo.pdf$$yPostprint
000070582 8564_ $$s61725$$uhttps://zaguan.unizar.es/record/70582/files/texto_completo.jpg?subformat=icon$$xicon$$yPostprint
000070582 909CO $$ooai:zaguan.unizar.es:70582$$particulos$$pdriver
000070582 951__ $$a2020-02-21-13:39:01
000070582 980__ $$aARTICLE