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Predictive and protective factors associated with upper gastrointestinal bleeding after percutaneous coronary
Marcus W S Chin1, Gerald Yong, Max K Bulsara
1Department of Gastroenterology and Hepatology, Royal Perth Hospital, Perth, Western Australia, Australia.
The American Journal of Gastroenterology
|September 14, 2007
Summary
Upper gastrointestinal bleeding after percutaneous coronary intervention (PCI) affects 1.2% of patients and is linked to higher mortality. Primary PCI, cardiac arrest, and advanced age are key risk factors, while proton pump inhibitors may reduce bleeding risk.
Area of Science:
- Cardiology
- Gastroenterology
- Interventional Cardiology
Background:
- Hemorrhagic complications post-percutaneous coronary intervention (PCI) increase mortality.
- Upper gastrointestinal (UGI) bleeding is a significant concern following PCI.
Purpose of the Study:
- To identify risk factors for UGI bleeding in PCI patients.
- To assess outcomes of medical and endoscopic management for UGI bleeding post-PCI.
Main Methods:
- A case-control study analyzed UGI bleeding within 30 days of PCI.
- Data linkage included institutional databases, vital statistics, and medical record review.
- Logistic regression identified risk and protective factors.
Main Results:
- UGI bleeding incidence was 1.2%; mortality was 11.9% in cases versus 0.5% in controls.
- Risk factors included primary PCI, cardiac arrest, inotropic support, thienopyridine use, and advanced age.
- Proton pump inhibitor use post-PCI was associated with reduced bleeding risk.
Conclusions:
- UGI bleeding post-PCI is common and associated with increased mortality.
- Patients undergoing PCI for acute myocardial infarction or with hemodynamic instability face the highest risk.
- Therapeutic endoscopy is safe and effective for managing UGI bleeding.
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