Correlates and consequences of gastrointestinal bleeding complicating percutaneous coronary intervention.

Abstract

Gastrointestinal bleeding (GIB) complicating percutaneous coronary intervention (PCI) results in high mortality, but clinical factors associated with and long-term outcomes of GIB are poorly understood. We sought to examine clinical and procedural factors associated with GIB complicating PCI. We also examined the impact of GIB on 30-day mortality and 1-year major adverse cardiac events (MACEs). Patients undergoing PCI from January 2000 to January 2010 were retrospectively analyzed for the occurrence of in-hospital GIB. Multivariable logistic regression and Cox proportional hazards regression were used to identify predictors of in-hospital GIB and 30-day mortality. Landmark analysis of patients surviving to hospital discharge was performed to assess the impact of GIB on 1-year MACEs. Of 20,621 patients who underwent PCI, 147 (0.72%) who developed in-hospital GIB were identified. 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; bivalirudin decreased the risk. Unadjusted 30-day mortality rate of patients with GIB was 20.5% compared to 2.4% of patients without GIB. After multivariable adjustment, GIB and shock (and an interaction between the 2) were the most important correlates of 30-day mortality. In the population surviving to discharge, however, GIB was not associated with adjusted mortality or MACEs. In conclusion, GIB complicating PCI has a dramatic impact on 30-day mortality, and bivalirudin was associated with lower rates of GIB.

• Authors: Michael A Gaglia Jr, Rebecca Torguson, Manuel A Gonzalez, Itsik Ben-Dor, Gabriel Maluenda, Sara D Collins, Asmir I Syed, Cedric Delhaye, Kohei Wakabayashi, Loic Belle, Michael Mahmoudi, Nicholas Hanna, Zhenyi Xue, Kimberly Kaneshige, William O Suddath, Kenneth M Kent, Lowell F Satler, Augusto D Pichard, Ron Waksman
• Journal: The American journal of cardiology (Am J Cardiol) Vol. 106 Issue 8 Pg. 1069-74 (Oct 15 2010) ISSN: 1879-1913 [Electronic] United States
• PMID: 20920640 (Publication Type: Comparative Study, Journal Article)
• Copyright: Copyright © 2010 Elsevier Inc. All rights reserved.

Chemical References

• Anticoagulants
• Antithrombins
• Hirudins
• Peptide Fragments
• Recombinant Proteins
• bivalirudin

Topics

• Aged
• Angioplasty, Balloon, Coronary (adverse effects)
• Anticoagulants (adverse effects)
• Antithrombins
• Blood Transfusion
• Drug-Eluting Stents (adverse effects)
• Female
• Follow-Up Studies
• Gastrointestinal Hemorrhage (epidemiology, etiology, prevention & control)
• Hirudins (adverse effects)
• Humans
• Incidence
• Inpatients
• Male
• Middle Aged
• Myocardial Infarction (blood, surgery)
• Peptide Fragments (adverse effects)
• Postoperative Hemorrhage (epidemiology, etiology, prevention & control)
• Prognosis
• Recombinant Proteins (adverse effects)
• Retrospective Studies
• Risk Factors
• Survival Rate (trends)
• Time Factors
• United States (epidemiology)