BACKGROUND: Gastrointestinal bleeding (GIB) after percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) and coronary artery disease (CAD) is associated with high morbidity and mortality. METHODS: The NIS database from 1998 to 2006 was used to identify 1,216,759 PCIs performed for ACS and CAD. We sought to analyze temporal trends in the incidence and in-hospital outcomes of GIB associated with PCI along with its predictors. RESULTS: The overall incidence of GIB was 1.04% (95% confidence interval (CI), 1.02%-1.06%). The incidence of GIB decreased over the study period (P for trend <.0001). The overall mortality in the GIB group was 6.0% (95% CI, 5.6%-6.4%). The adjusted OR for in-hospital mortality and GIB was 4.70 (95% CI, 4.23-5.23; P < .0001); this remained high and essentially unchanged over the study period. Independent predictors of GIB included rectum/anal cancer (OR, 4.64; 95% CI, 3.20-6.73; P < .0001), stomach cancer (OR, 2.74; 95% CI, 1.62-4.66; P = .0002), esophageal cancer (OR, 1.99; 95% CI, 1.08-3.69; P = .0288), colon cancer (OR, 1.69; 95% CI, 1.43-2.02; P < .0001), congestive heart failure (OR, 1.43; 95% CI, 1.35-1.52; P < .0001), and acute myocardial infarction (OR, 1.23; 95% CI, 1.13-1.35; P < .0001). CONCLUSIONS: Although the incidence of GIB associated with PCI decreased from 1998 to 2006 in the face of aggressive therapies for ACS and CAD, the risk of GIB-associated death remained high. Underlying GI malignancy is a significant independent predictor of GIB associated with PCI; identifying these patients may reduce the rate of GIB.
BACKGROUND:Gastrointestinal bleeding (GIB) after percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) and coronary artery disease (CAD) is associated with high morbidity and mortality. METHODS: The NIS database from 1998 to 2006 was used to identify 1,216,759 PCIs performed for ACS and CAD. We sought to analyze temporal trends in the incidence and in-hospital outcomes of GIB associated with PCI along with its predictors. RESULTS: The overall incidence of GIB was 1.04% (95% confidence interval (CI), 1.02%-1.06%). The incidence of GIB decreased over the study period (P for trend <.0001). The overall mortality in the GIB group was 6.0% (95% CI, 5.6%-6.4%). The adjusted OR for in-hospital mortality and GIB was 4.70 (95% CI, 4.23-5.23; P < .0001); this remained high and essentially unchanged over the study period. Independent predictors of GIB included rectum/anal cancer (OR, 4.64; 95% CI, 3.20-6.73; P < .0001), stomach cancer (OR, 2.74; 95% CI, 1.62-4.66; P = .0002), esophageal cancer (OR, 1.99; 95% CI, 1.08-3.69; P = .0288), colon cancer (OR, 1.69; 95% CI, 1.43-2.02; P < .0001), congestive heart failure (OR, 1.43; 95% CI, 1.35-1.52; P < .0001), and acute myocardial infarction (OR, 1.23; 95% CI, 1.13-1.35; P < .0001). CONCLUSIONS: Although the incidence of GIB associated with PCI decreased from 1998 to 2006 in the face of aggressive therapies for ACS and CAD, the risk of GIB-associated death remained high. Underlying GI malignancy is a significant independent predictor of GIB associated with PCI; identifying these patients may reduce the rate of GIB.
Authors: Stephen D Wiviott; Eugene Braunwald; Carolyn H McCabe; Gilles Montalescot; Witold Ruzyllo; Shmuel Gottlieb; Franz-Joseph Neumann; Diego Ardissino; Stefano De Servi; Sabina A Murphy; Jeffrey Riesmeyer; Govinda Weerakkody; C Michael Gibson; Elliott M Antman Journal: N Engl J Med Date: 2007-11-04 Impact factor: 91.245
Authors: Herbert D Aronow; Steven R Steinhubl; Danielle M Brennan; Peter B Berger; Eric J Topol Journal: Am Heart J Date: 2008-11-01 Impact factor: 4.749
Authors: Steven V Manoukian; Frederick Feit; Roxana Mehran; Michele D Voeltz; Ramin Ebrahimi; Martial Hamon; George D Dangas; A Michael Lincoff; Harvey D White; Jeffrey W Moses; Spencer B King; E Magnus Ohman; Gregg W Stone Journal: J Am Coll Cardiol Date: 2007-03-09 Impact factor: 24.094
Authors: Gregg W Stone; Bernhard Witzenbichler; Giulio Guagliumi; Jan Z Peruga; Bruce R Brodie; Dariusz Dudek; Ran Kornowski; Franz Hartmann; Bernard J Gersh; Stuart J Pocock; George Dangas; S Chiu Wong; Ajay J Kirtane; Helen Parise; Roxana Mehran Journal: N Engl J Med Date: 2008-05-22 Impact factor: 91.245
Authors: Eric D Peterson; Bimal R Shah; Lori Parsons; Charles V Pollack; William J French; John G Canto; C Michael Gibson; William J Rogers Journal: Am Heart J Date: 2008-11-01 Impact factor: 4.749