title: Pantoprazole for the prevention of gastrointestinal bleeding in high-risk patients with acute coronary syndromes.
abstract: OBJECTIVE
  The aim of this study is to evaluate the preventive effect of proton pump inhibitors on gastrointestinal (GI) bleeding in patients with acute coronary syndromes (ACS) who are at high risk for GI bleeding.
  
  
  METHODS
  We enrolled 665 patients with ACS who had one or more of the following risk factors for GI bleeding: 75 years of age or older, history of peptic ulcer disease, history of GI bleeding, cardiogenic shock, and chronic renal dysfunction (serum creatinine, >2 mg/dL). Patients were randomly assigned to receive 40 mg of pantoprazole or placebo twice daily for 7 days, in addition to standard treatment of ACS. The primary end point was the occurrence of GI bleeding during hospitalization.
  
  
  RESULTS
  During a median time of hospitalization of 12 days, 12 (3.6%) of 332 patients in the placebo group had an occurrence of GI bleeding, as compared with 4 (1.2%) of the 333 patients in the pantoprazole group (P = .046, Fisher exact test). The log-rank test showed a significant difference between the 2 groups in the time to the occurrence of GI bleeding (P = .015). Major GI bleeding occurred in 5 (1.5%) patients in the placebo group but only in 1 (0.3%) in the pantoprazole group (P = .12). Pneumonia developed in 22 (6.6%) patients in the placebo group and 24 (7.2%) in the pantoprazole group (χ(2) = 0.077, P = .88). The 30-day mortality was 10.2% (34/332) in the placebo group and 10.5% (35/333) in the pantoprazole group.
  
  
  CONCLUSIONS
  In patients with ACS who are at high risk for GI hemorrhage, prophylactic treatment with pantoprazole could reduce the risk of GI bleeding with no significant effects on the incidence of hospital-acquired pneumonia and 30-day mortality.
authors.affiliation: Institute of Geriatric Cardiology, Chinese PLA General Hospital, Beijing 100853, People's Republic of China. Why46301@163.com
authors.forename: Haiyun
authors.initials: H
authors.lastname: Wu
authors.forename: Quanmin
authors.initials: Q
authors.lastname: Jing
authors.forename: Junhua
authors.initials: J
authors.lastname: Wang
authors.forename: Xinghong
authors.initials: X
authors.lastname: Guo
mesh_terms: D053799:2-Pyridinylmethylsulfinylbenzimidazoles / Q000627:therapeutic use*; D054058:Acute Coronary Syndrome / Q000150:complications*; D000367:Age Factors; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D016009:Chi-Square Distribution; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000517:prevention & control*; D006801:Humans; D008297:Male; D000077402:Pantoprazole; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D012189:Retrospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
chemical_list: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D054328:Proton Pump Inhibitors; D000077402:Pantoprazole