Gastrointestinal Bleeding and Outcomes After Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction

Abstract

Background Gastrointestinal bleeding is a hemorrhagic complication after primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction (STEMI). Objectives To determine predictors of gastrointestinal bleeding and the impact of gastrointestinal bleeding on outcomes in STEMI patients undergoing primary percutaneous coronary intervention. Methods and ResultsGastrointestinal bleeding occurred in 18 (3.5%) of 519 consecutive patients with STEMI undergoing primary percutaneous coronary intervention. Univariate predictors of gastrointestinal bleeding were previous gastrointestinal bleeding (33% vs 4%, P < .001), impaired renal function (89% vs 37%, P < .001), Killip class IV at presentation (61% vs 18%, P < .001), higher peak creatinine kinase level (mean [SD], 3801.6 [3280.2] vs 2721.3 [2286.6] IU/L, P = .05), and mechanical ventilator support (44% vs 12%, P < .001). Co pre scription of proton-pump inhibitors did not reduce the risk of gas tro in tes ti nal bleeding (22.2% vs 13.4%, P = .22). Multivariate analysis showed an odds ratio (95% confidence interval) for gastrointestinal bleeding of 22.1 (5.6-86.89, P < .001) for previous gastrointestinal bleeding, 6.74 (1.30-34.89, P = .02) for impaired renal function, and 4.68 (1.35-16.2, P = .01) for Killip class IV at pres en tation. Gastrointestinal bleeding was associated with longer inten sive care unit stay (mean [SD], 5.4 [6.7] vs 3.6 [3.6] days, P = .04), and higher in-hospital (44% vs 9%, P < .001) and overall (44% vs 13%, P < .001) mortality rate. Conclusions Although rare, gastrointestinal bleeding in patients with STEMI significantly prolongs intensive care unit stay and increases mortality. Previous gastrointestinal bleeding, impaired renal function, and Killip class IV at presentation are associated with higher incidence of gastrointestinal bleeding.

Predictors and prognostic consequence of gastrointestinal bleeding in patients with ST-segment elevation myocardial infarction

“…In the present analysis we found that approximately 8% of STEMI patients developed a GI bleeding within 6 years follow-up. The in-hospital occurrence of GI bleeding has been found to vary between 0.72% in patients undergoing PCI and 3.5% in STEMI patients [19,20]. The higher incidence of GI bleeding in PPCI treated STEMI patients can be explained by the higher prevalence of cardiogenic shock in STEMI patients as compared to unstable angina and NSTEMI [21].…”

Access and Non–Access Site Bleeding After Percutaneous Coronary Intervention and Risk of Subsequent Mortality and Major Adverse Cardiovascular Events

“…Figures 2 and 3 show the risk of mortality and MACE considering unadjusted and adjusted results separately. Eight of the 10 studies reported crude mortality rate 6,10,14,[16][17][18][19]21 which was 13% in patients experiencing a gastrointestinal bleed (96/738) and 3% in the remaining cohort (1898/55 771). There was a significant risk of mortality with gastrointestinal bleeding …”

“…We retrieved 25 relevant studies of patients that underwent PCI (total number of subjects 2 400 645), which evaluated the risk of adverse events with and without major bleeding. 2,[4][5][6][7][8][9][10][11][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] Excluded studies are shown in Table II in the Data Supplement. The patient cohort size ranged from 73 to 1 216 759, and 106 490 major bleeding events were recorded (23 studies, 4.5%).…”

“…The patient cohort size ranged from 73 to 1 216 759, and 106 490 major bleeding events were recorded (23 studies, 4.5%). Twenty-two studies evaluated mortality as an outcome 2,6,[8][9][10][11]14,[16][17][18][19][20][21] and 9 studies reported on MACE. 5,7,14,15,19,23,[25][26][27] …”

Effects of the short-term application of pantoprazole combined with aspirin and clopidogrel in the treatment of acute STEMI

“…The administration of high doses of aspirin, clopidogrel and low molecular weight heparin in acute STEMI patients and their own perioperative stress response, particularly in patients undergoing PCI surgery, leads to a significantly increased risk of gastrointestinal bleeding (6). Numerous studies have shown its high incidence mainly during the first week of the course of disease (7,8).…”