Predictors and consequences of postdischarge gastrointestinal bleeding after percutaneous coronary intervention

Zhu, Peng; Tang, Xiaofang; Song, Ying; Liu, Ru; Yin, Zhang; Gao, Lijian; Gao, Zhan; Chen, Jue; Yang, Yuejin; Gao, Runlin; Xu, Bo; Yuan, Jinqing

doi:10.1111/1755-5922.12440

Cited by 4 publications

(2 citation statements)

References 23 publications

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“…[ 23 ] High-dose or multi-drug combined anticoagulation may cause acute gastrointestinal bleeding after PCI. Zhu et al [ 24 ] indicated that renal dysfunction was an independent risk factor of post-discharge 1-year GIB after PCI. Similarly, Gaglia et al [ 25 ] found that variables associated with increased risk of GIB included older age, shock, acute myocardial infarction, chronic renal insufficiency, lower baseline hematocrit, and glycoprotein IIb/IIIa inhibitors in their study.…”

Section: Discussionmentioning

confidence: 99%

Prediction of gastrointestinal bleeding events in patients with acute coronary syndrome undergoing percutaneous coronary intervention

et al. 2020

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Bleeding complications of acute coronary syndromes (ACS) after percutaneous coronary intervention (PCI) are strongly associated with adverse patient outcomes, and gastrointestinal bleeding (GIB) is the most common major bleeding event, especially in the early post-PCI period. Current guidelines recommend routinely conducting bleeding risk assessments. The existing tools are mainly used to evaluate the overall bleeding risk and guide the adjustment of antithrombotic strategies after 1 year. However, there are no specific tools for GIB risk assessment. Between January 2015 and June 2015, 4943 ACS patients underwent PCI were consecutively enrolled in the derivation cohort. GIB, cardiovascular, and cerebrovascular events were recorded within 1 year of follow-up. A validation cohort including 1000 patients who met the same inclusion and exclusion criteria was also established by propensity-score matching baseline characteristics. Multivariable cox proportional-hazards regression model was used to derive a risk-scoring system, and predictive variables were selected. A risk score nomogram based on the risk prediction model was created to estimate the 1-year risk of GIB. In this study, we found that the usage of clopidogrel (hazard ratio, HR: 2.52, 95% confidence intervals, CI: 1.573–4.021) and glycoprotein IIb/IIIa receptor inhibitors (HR: 1.863, 95% CI: 1.226–2.829), history of peptic ulcers (HR: 3.601, 95% CI: 1.226–2.829) or tumor (HR: 4.884, 95% CI: 1.226–2.829), and cardiac insufficiency (HR: 11.513, 95% CI: 7.282–18.202), renal insufficiency (HR: 2.010, 95% CI: 1.350–2.993), and prolonged activated partial thromboplastin time (HR: 4.639, 95% CI: 2.146–10.032) were independent risk factors for GIB 1 year after PCI. Based on these 7 factors, a nomogram and scoring system was established. The area under curve of risk score was 0.824 in the deviation cohort and 0.810 in the verification cohort. In both cohorts, the GIB score was significantly better than that of 3 classical bleeding scores (all P < .05). This score could well predict the risk of GIB within 1 year after PCI and could be used to guide antithrombotic strategies.

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Section: Discussionmentioning

confidence: 99%

Prediction of gastrointestinal bleeding events in patients with acute coronary syndrome undergoing percutaneous coronary intervention

et al. 2020

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“…3,4 Primary PCI has been shown to be very successful in restoring the patency of coronary arteries after acute myocardial infarction and thus in this way salvaging the ischemic myocardium. 5,6 Acute gastrointestinal tract bleeding after the invasive coronary artery procedures has been extensively studied for its predictive risk factors and clinical impacts and these are well documented in the literature. 7,8 However little data is present for Post-graduate teaching hospitals, tertiary care hospitals and National cardiology Institutes in Pakistan.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of Acute Gastro Intestinal Tract Bleeding in Patients Undergoing Primary Percutaneous Coronary Intervention After Acute Myocardial Infarction

Tariq

Samore²,

Rashid³

et al. 2022

PAFMJ

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Objective: To determine the prevalence of acute gastro-intestinal tract bleeding and the factors associated with it in patients undergoing Primary PCI after acute myocardial infarction. Study Design: Analytical Cross sectional study. Place and Duration of Study: Department of Interventional Cardiology, Tertiary Cardiac Care Center, Rawalpindi Pakistan, from May 2021 to April 2022. Methodology: Five hundred patients (n =500) between 30-80 years of age, presented at the emergency of Tertiary cardiac care center, Rawalpindi and diagnosed with Acute Myocardial Infarction were planned to undergo the Primary Percutaneous Coronary Intervention (PCI) procedure. After the procedure, patients were evaluated for acute gastro-intestinal tract bleeding within first 48 hrs. Blood samples were taken before and after 24 hrs and 72 hrs of primary PCI. The blood hemoglobin level was assessed and fall in its level was noted. SPSS 26 was used to enter and analyze the collected data. Results: Out of n=500 patients enrolled in the study, 440(88%) were males and 60(12%) were females. The mean age of patients was 64.27 ± 6.47 years. The mean time from symptoms onset to primary PCI was 9.74±5.15 hrs. The mean duration of the procedure was 34.99 ± 6.01 mins. After the procedure, 23(4.60%) patients had developed the acute gastro-intestinal tract bleeding. In patients who developed acute gastro-intestinal bleeding, mean blood hemoglobin level before the procedure was 11.95 ± 1.05 g/dl, which was reduced to 8.46 ± 0.51 g/dl after the procedure. In patients who did not develop it, the mean blood hemoglobin level before the procedure was 11.94±1.03 g/dl, which was reduced to 11.80 ± 1.04 g/dl after the procedure. The blood hemoglobin level after the procedure was significantly less in patients who suffered from acute gastro-intestinal tract bleeding. Conclusion: The research study concluded that the frequency of acute gastro-intestinal tract bleeding in patients after primary PCI for acute myocardial infarction was very low but on the other hand marked reduction in blood hemoglobin level was observed, which can lead to many adverse sequelae.

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Percutaneous Coronary Intervention in Patients With a History of Gastrointestinal Bleeding (From the Blue Cross Blue Shield of Michigan Cardiovascular Consortium)

Meloche

Seth

Madder

et al. 2021

The American Journal of Cardiology

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Predictors and consequences of postdischarge gastrointestinal bleeding after percutaneous coronary intervention

Abstract: In this large cohort of real-world patients after PCI, postdischarge GIB was not significantly associated with MACCE up to 2 years of follow-up but lead to an increase in DAPT cessation, and DAPT cessation was strongly associated with 2-year mortality.

Cited by 4 publications

References 23 publications

Prediction of gastrointestinal bleeding events in patients with acute coronary syndrome undergoing percutaneous coronary intervention

Prediction of gastrointestinal bleeding events in patients with acute coronary syndrome undergoing percutaneous coronary intervention

Prevalence of Acute Gastro Intestinal Tract Bleeding in Patients Undergoing Primary Percutaneous Coronary Intervention After Acute Myocardial Infarction

Percutaneous Coronary Intervention in Patients With a History of Gastrointestinal Bleeding (From the Blue Cross Blue Shield of Michigan Cardiovascular Consortium)

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