In-hospital gastrointestinal bleeding following percutaneous coronary intervention.
Age Factors
Aged
Aged, 80 and over
Cause of Death
Databases, Factual
England
/ epidemiology
Female
Gastrointestinal Hemorrhage
/ diagnosis
Heart-Assist Devices
/ adverse effects
Humans
Incidence
Inpatients
Length of Stay
Male
Middle Aged
Myocardial Ischemia
/ diagnostic imaging
Percutaneous Coronary Intervention
/ adverse effects
Platelet Aggregation Inhibitors
/ adverse effects
Risk Assessment
Risk Factors
ST Elevation Myocardial Infarction
/ diagnosis
Sex Factors
Time Factors
Treatment Outcome
Wales
/ epidemiology
bleeding
coronary artery disease
percutaneous coronary intervention
Journal
Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions
ISSN: 1522-726X
Titre abrégé: Catheter Cardiovasc Interv
Pays: United States
ID NLM: 100884139
Informations de publication
Date de publication:
01 2020
01 2020
Historique:
received:
28
11
2018
revised:
26
02
2019
accepted:
23
03
2019
pubmed:
10
4
2019
medline:
15
9
2020
entrez:
10
4
2019
Statut:
ppublish
Résumé
This study aims to examine in-hospital gastrointestinal (GI) bleeding, its predictors and clinical outcomes, including long-term outcomes, in a national cohort of patients undergoing percutaneous coronary intervention (PCI) in England and Wales. GI bleeding remains associated with significant morbidity, mortality, and socioeconomic burden. We examined the temporal changes in in-hospital GI bleeding in a national cohort of patients undergoing PCI between 2007 and 2014 in England and Wales, its predictors and prognostic consequences. Multivariate analysis was performed to identify independent risk factors between GI bleeding and 30-day mortality. Survival analysis was performed comparing patients with, and without, GI bleeding. There were 480 in-hospital GI bleeds in 549,298 patients (0.09%). Overall, rates of GI bleeding remained stable over time but a significant decline was observed for patients with ST segment elevation myocardial infarction (STEMI). The strongest predictors of bleeding events were STEMI-odds ratio (OR) 7.28 (95% confidence interval [95% CI] 4.82-11.00), glycoprotein IIb/IIIa inhibitor use OR 3.42 (95% CI 2.76-4.24) and use of circulatory support OR 2.65 (95% CI 1.90-3.71). Antiplatelets/coagulants (clopidogrel, prasugrel, and warfarin) were not independently associated with GI bleeding. GI bleeding was independently associated with a significant increase in all-cause 30-day mortality (OR 2.08 [1.52-2.83]). Patients with in-hospital GI bleed who survived to 30-days had increased all-cause mortality risk at 1 year compared to non-bleeders (HR 1.49 [1.07-2.09]). In-hospital GI bleeding following PCI is rare but is a clinically important event associated with increased 30-day and long-term mortality.
Sections du résumé
OBJECTIVES
This study aims to examine in-hospital gastrointestinal (GI) bleeding, its predictors and clinical outcomes, including long-term outcomes, in a national cohort of patients undergoing percutaneous coronary intervention (PCI) in England and Wales.
BACKGROUND
GI bleeding remains associated with significant morbidity, mortality, and socioeconomic burden.
METHODS
We examined the temporal changes in in-hospital GI bleeding in a national cohort of patients undergoing PCI between 2007 and 2014 in England and Wales, its predictors and prognostic consequences. Multivariate analysis was performed to identify independent risk factors between GI bleeding and 30-day mortality. Survival analysis was performed comparing patients with, and without, GI bleeding.
RESULTS
There were 480 in-hospital GI bleeds in 549,298 patients (0.09%). Overall, rates of GI bleeding remained stable over time but a significant decline was observed for patients with ST segment elevation myocardial infarction (STEMI). The strongest predictors of bleeding events were STEMI-odds ratio (OR) 7.28 (95% confidence interval [95% CI] 4.82-11.00), glycoprotein IIb/IIIa inhibitor use OR 3.42 (95% CI 2.76-4.24) and use of circulatory support OR 2.65 (95% CI 1.90-3.71). Antiplatelets/coagulants (clopidogrel, prasugrel, and warfarin) were not independently associated with GI bleeding. GI bleeding was independently associated with a significant increase in all-cause 30-day mortality (OR 2.08 [1.52-2.83]). Patients with in-hospital GI bleed who survived to 30-days had increased all-cause mortality risk at 1 year compared to non-bleeders (HR 1.49 [1.07-2.09]).
CONCLUSIONS
In-hospital GI bleeding following PCI is rare but is a clinically important event associated with increased 30-day and long-term mortality.
Substances chimiques
Platelet Aggregation Inhibitors
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
109-117Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2019 Wiley Periodicals, Inc.
Références
Keeley EC, Boura JA, Grines CL. Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trials. Lancet. 2003;361:13-20.
Chhatriwalla AK, Amin AP, Kennedy KF, et al. Association between bleeding events and in-hospital mortality after percutaneous coronary intervention. JAMA. 2013;309:1022-1029.
Kwok CS, Rao SV, Myint PK, et al. Major bleeding after percutaneous coronary intervention and risk of subsequent mortality: a systematic review and meta-analysis. Open Heart. 2014;1:e000021.
Genereux P, Giustino G, Witzenbichler B, et al. Incidence, predictors, and impact of post-discharge bleeding after percutaneous coronary intervention. J am Coll Cardiol. 2015;66:1036-1045.
Ergelen M, Uyarel H, Soylu O, et al. Gastrointestinal bleeding in patients undergoing primary angioplasty for acute myocardial infarction: incidence, risk factors and prognosis. Turk Kardiyol Dern Ars. 2010;38:101-106.
Koskinas KC, Raber L, Zanchin T, et al. Clinical impact of gastrointestinal bleeding in patients undergoing percutaneous coronary interventions. Circ Cardiovasc Interv. 2015;8:e002053.
Patel NJ, Pau D, Nalluri N, et al. Temporal trends, predictors, and outcomes of in-hospital gastrointestinal bleeding associated with percutaneous coronary intervention. Am J Cardiol. 2016;118:1150-1157.
Chua SK, Liao CS, Hung HF, et al. Gastrointestinal bleeding and outcomes after percutaneous coronary intervention for ST-segment elevation myocardial infarction. Am J Crit Care. 2011;20:218-225.
Abbas AE, Brodie B, Dixon S, et al. Incidence and prognostic impact of gastrointestinal bleeding after percutaneous coronary intervention for acute myocardial infarction. Am J Cardiol. 2005;96:173-176.
Mamas MA, Nolan J, de Belder MA, et al. Changes in arterial access site and association with mortality in the United Kingdom: observations from a National Percutaneous Coronary Intervention Database. Circulation. 2016;133:1655-1667.
Rorbaek-Madsen M, Fischer L, Thomsen H, Wara P. Late outcome of bleeding gastric ulcer. Five to eight years' follow-up. Scand J Gastroenterol. 1994;29:983-987.
Smart HL, Langman MJ. Late outcome of bleeding gastric ulcers. Gut. 1986;27:926-928.
Kwok CS, Kontopantelis E, Myint PK, et al. Stroke following percutaneous coronary intervention: type-specific incidence, outcomes and determinants seen by the British Cardiovascular Intervention Society 2007-12. Eur Heart J. 2015;36:1618-1628.
Kwok CS, Kontopantelis E, Kunadian V, et al. Effect of access site, gender, and indication on clinical outcomes after percutaneous coronary intervention: insights from the British Cardiovascular Intervention Society (BCIS). Am Heart J. 2015;170:164-172.
Chin MW, Yong G, Bulsara MK, Rankin J, Forbes GM. Predictive and protective factors associated with upper gastrointestinal bleeding after percutaneous coronary intervention: a case-control study. Am J Gastroenterol. 2007;102:2411-2416.
van der Spoel JI, Schultz MJ, van der Voort PH, de Jonge E. Influence of severity of illness, medication and selective decontamination on defecation. Intensive Care Med. 2006;32:875-880.
Yang YX, Lewis JD. Prevention and treatment of stress ulcers in critically ill patients. Semin Gastrointest Dis. 2003;14:11-19.
Cook DJ, Reeve BK, Guyatt GH, et al. Stress ulcer prophylaxis in critically ill patients. Resolving discordant meta-analyses. JAMA. 1996;275:308-314.
Alhazzani W, Alshamsi F, Belley-Cote E, et al. Efficacy and safety of stress ulcer prophylaxis in critically ill patients: a network meta-analysis of randomized trials. Intensive Care Med. 2018;44:1-11.
Task Force on the management of ST-segement elevation acute myocardial infarction, Van de Werf F, Bax J, et al. ESC guidelines on management of acute myocardial infarction in patients presenting with persistent ST-segment elevation. Rev Esp Cardiol. 2009;62:293-247.
Li L, Geraghty OC, Mehta Z, Rothwell PM, Oxford Vascular Study. Age-specific risks, severity, time course, and outcome of bleeding on long-term antiplatelet treatment after vascular events: a population-based cohort study. Lancet. 2017;390:490-499.
Ruigomez A, Garcia Rodriguez LA, Hasselgren G, Johansson S, Wallander MA. Overall mortality among patients surviving an episode of peptic ulcer bleeding. J Epidemiol Community Health. 2000;54:130-133.
Hudson N, Faulkner G, Smith SJ, Langman MJ, Hawkey CJ, Logan RF. Late mortality in elderly patients surviving acute peptic ulcer bleeding. Gut. 1995;37:177-181.
Nagata N, Sakurai T, Shimbo T, et al. Acute severe gastrointestinal tract bleeding is associated with an increased risk of thromboembolism and death. Clin Gastroenterol Hepatol. 2017;15:1882-1889.
Kyaw MH, Lau JYW. High rate of mortality more than 30 days after upper gastrointestinal bleeding. Clin Gastroenterol Hepatol. 2017;15:1858-1859.
Laursen SB, Hansen JM, Hallas J, Schaffalitzky de Muckadell OB. The excess long-term mortality in peptic ulcer bleeding is explained by nonspecific comorbidity. Scand J Gastroenterol. 2015;50:145-152.
Blatchford O, Murray WR, Blatchford M. A risk score to predict need for treatment for upper-gastrointestinal haemorrhage. Lancet. 2000;356:1318-1321.
Vreeburg EM, Terwee CB, Snel P, et al. Validation of the Rockall risk scoring system in upper gastrointestinal bleeding. Gut. 1999;44:331-335.
Odutayo A, Desborough MJ, Trivella M, et al. Restrictive versus liberal blood transfusion for gastrointestinal bleeding: a systematic review and meta-analysis of randomised controlled trials. Lancet Gastroenterol Hepatol. 2017;2:354-360.
Kwok CS, Sherwood MW, Watson SM, et al. Blood transfusion after percutaneous coronary intervention and risk of subsequent adverse outcomes: a systematic review and meta-analysis. JACC Cardiovasc Interv. 2015;8:436-446.
Rao SV, McCoy LA, Spertus JA, et al. An updated bleeding model to predict the risk of post-procedure bleeding among patients undergoing percutaneous coronary intervention: a report using an expanded bleeding definition from the National Cardiovascular Data Registry CathPCI Registry. JACC Cardiovasc Interv. 2013;6:897-904.
Mehran R, Pocock SJ, Nikolsky E, et al. A risk score to predict bleeding in patients with acute coronary syndromes. J Am Coll Cardiol. 2010;55:2556-2566.
Singh M. Bleeding avoidance strategies during percutaneous coronary interventions. J Am Coll Cardiol. 2015;65:2225-2238.