Acute gastrointestinal bleeding after percutaneous coronary intervention

Safety of gastrointestinal endoscopy in patients with acute coronary syndrome and concomitant gastrointestinal bleeding

BACKGROUND

Gastrointestinal bleeding (GIB) is a major concern in patients hospitalized with acute coronary syndrome (ACS) due to the common use of both antiplatelet medications and anticoagulants. Studies evaluating the safety of gastrointestinal endoscopy (GIE) in ACS patients with GIB are limited by their relatively small size, and the focus has generally been on upper GIB and esophago-gastroduod-enoscopy (EGD) only.

AIM

To evaluate the safety profile and the hospitalization outcomes of undergoing GIE in patients with ACS and concomitant GIB using the national database for hospitalized patients in the United States.

METHODS

The Nationwide Inpatient Sample database was queried to identify patients hospitalized with ACS and GIB during the same admission between 2005 and 2014. The International Classification of Diseases Code, 9^th Revision Clinical Modification was utilized for patient identification. Patients were further classified into two groups based on undergoing endoscopic procedures (EGD, small intestinal endoscopy, colonoscopy, or flexible sigmoidoscopy). Both groups were compared regarding demographic information, outcomes, and comorbi-dities. Multivariate analysis was conducted to identify factors associated with mortality and prolonged length of stay. Chi-square test was used to compare categorical variables, while Student’s t-test was used to compare continuous variables. All analyses were performed using SAS 9.4 (Cary, NC, United States).

RESULTS

A total of 35612318 patients with ACS were identified between January 2005 and December 2014. 269483 (0.75%) of the patients diagnosed with ACS developed concomitant GIB during the same admission. At least one endoscopic procedure was performed in 68% of the patients admitted with both ACS and GIB. Patients who underwent GIE during the index hospitalization with ACS and GIB had lower mortality (3.8%) compared to the group not undergoing endoscopy (8.6 %, P < 0.001). A shorter length of stay (LOS) was observed in patients who underwent GIE (mean 6.59 ± 7.81 d) compared to the group not undergoing endoscopy (mean 7.84 ± 9.73 d, P < 0.001). Multivariate analysis showed that performing GIE was associated with lower mortality (odds ratio: 0.58, P < 0.001) and shorter LOS (-0.36 factor, P < 0.001).

CONCLUSION

Performing GIE during the index hospitalization of patients with ACS and GIB was correlated with a better mortality rate and a shorter LOS. Approximately two-thirds of patients with both ACS and GIB undergo GIE during the same hospitalization.

Inpatient Outcomes for Gastrointestinal Bleeding Associated With Percutaneous Coronary Intervention

GOALS

The goal of this study was to evaluate the impact of inpatient outcomes of gastrointestinal bleeding (GIB) related to percutaneous coronary intervention (PCI).

BACKGROUND

With all-cause mortality increasing in patients undergoing PCIs, outcomes for GIB associated with PCI may be adversely impacted.

STUDY

Using the National Inpatient Sample (2007 to 2012), we performed a nested case-control study assessing inpatient outcomes including incidence and mortality for PCI-related GIB hospitalizations. Multivariate logistic regression analyses were performed to determine significant predictors for GIB incidence and mortality.

RESULTS

A total of 9332 (1.2%) of PCI hospitalizations were complicated by GIB with the age-adjusted incidence rate increasing 13% from 2007 (11.3 GIB per 1000 PCI) to 2012 (12.8). Patients ≥75 years of age experienced the steepest incline in GIB incidence, which increased 31% during the study period. Compared with non-GIB patients, mean length of stay (9.4 d vs. 3.3 d) and median cost of care ($29,236 vs. $17,913) was significantly higher. Significant demographic risk factors for GIB included older age and comorbid risk factors included gastritis or duodenitis, and Helicobacter pylori infection.In total, 1044 (11%) of GIB patients died during hospitalization with the GIB mortality rate increasing 30% from 2007 (95 deaths per 1000 GIB) to 2012 (123). Older age had the strongest association with inpatient mortality.

CONCLUSIONS

Inpatient incidence and mortality for PCI-related GIB has been increasing particularly with a large increase in incidence among older patients. A multidisciplinary approach focused on risk-stratifying patients may improve preventable causes of GIB.

Pantoprazole for prevention and treatment of gastrointestinal bleeding in elderly patients after percutaneous coronary intervention

AIM: To assess the effect of pantoprazole in the prevention and treatment of gastrointestinal bleeding in elderly patients after percutaneous coronary intervention (PCI).

METHODS: Three hundred elderly patients who underwent PCI for coronary heart disease from May 2011 to May 2013 at Wuchang Hospital were randomly divided into a control group and an observation group. Both groups were given clopidogrel and aspirin antiplatelet therapy, and the observation group was additionally given pantoprazole. Gastrointestinal bleeding and gastrointestinal adverse reactions such as cardiovascular and cerebrovascular adverse events and platelet aggregation (PA) were compared for the two groups.

RESULTS: In the observation group, no patients developed gastrointestinal bleeding and 6 patients had gastrointestinal discomfort. In the control group, 14 patients developed gastrointestinal bleeding and 31 patients had gastrointestinal discomfort. The rates of gastrointestinal bleeding and gastrointestinal discomfort for the observation group were significantly lower than those for the control group (P < 0.05). After 1 wk of treatment, PA levels decreased significantly in both groups compared with the levels before treatment (P < 0.05). As time went on, PA levels decreased progressively. PA levels between the two groups at any time point did not differ significantly (P > 0.05). The incidence of cardiovascular and cerebrovascular adverse events was 8.67% for patients in the observation group, slightly higher than 8% of the control group (P > 0.05).

CONCLUSION: The application of pantoprazole after PCI reduces the incidence of gastrointestinal bleeding and gastrointestinal discomfort, and does not significantly affect the patient's PA or increase the incidence of cardiovascular and cerebrovascular adverse events.