Related Experiment Videos

Gastrointestinal bleeding and outcomes after percutaneous coronary intervention for ST-segment elevation myocardial

Su-Kiat Chua1, Chao-Sheng Liao, Huei-Fong Hung

  • 1Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.

American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses
|May 3, 2011
PubMed

Insights

Gastrointestinal bleeding is a serious complication after ST-segment elevation myocardial infarction (STEMI) treatment. Previous bleeding, kidney dysfunction, and severe heart failure predict its occurrence and worsen patient outcomes.

Area of Science:

  • Cardiology
  • Gastroenterology
  • Critical Care Medicine

Background:

  • Gastrointestinal bleeding is a known hemorrhagic complication following primary percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI) patients.
  • Understanding predictors and outcomes of this complication is crucial for patient management.

Purpose of the Study:

  • To identify predictors of gastrointestinal bleeding in STEMI patients undergoing primary PCI.
  • To assess the impact of gastrointestinal bleeding on patient outcomes, including intensive care unit (ICU) stay and mortality.

Main Methods:

  • A retrospective analysis of 519 consecutive STEMI patients undergoing primary PCI.
  • Univariate and multivariate logistic regression analyses were used to determine predictors.
  • Outcomes such as ICU stay and mortality were compared between patients with and without gastrointestinal bleeding.

Main Results:

  • Gastrointestinal bleeding occurred in 3.5% of patients.
  • Key predictors included prior gastrointestinal bleeding, impaired renal function, and Killip class IV presentation.
  • Gastrointestinal bleeding was significantly associated with longer ICU stays and increased in-hospital and overall mortality.

Conclusions:

  • Gastrointestinal bleeding, though infrequent, substantially increases ICU stay and mortality in STEMI patients post-primary PCI.
  • Previous gastrointestinal bleeding, impaired renal function, and Killip class IV are significant risk factors.
  • Proton-pump inhibitor use did not demonstrate a significant risk reduction.
Abstract

Related Concept Videos

Acute Coronary Syndrome I: Introduction01:30

Acute Coronary Syndrome I: Introduction

Acute Coronary Syndrome (ACS) encompasses a spectrum of heart conditions caused by sudden obstruction of coronary arteries, typically resulting from the rupture of an atherosclerotic plaque and subsequent thrombus (blood clot) formation. This obstruction can lead to partial or complete blockage of blood flow, causing varying degrees of myocardial ischemia or infarction.ACS includes the following clinical entities:Unstable Angina (UA)Non-ST-Elevation Myocardial Infarction (NSTEMI)ST-Elevation...
Esophageal Perforation-II: Clinical Manifestations and Management01:28

Esophageal Perforation-II: Clinical Manifestations and Management

Esophageal perforations manifest in various clinical forms, influenced by factors such as the perforation's cause and location (cervical, intrathoracic, or intra-abdominal), the extent of contamination, and potential injury to adjacent mediastinal structures. The timing between the perforation occurrence and treatment initiation also affects the clinical presentation.
Clinical Manifestations:
Acute Coronary Syndrome IV: Interprofessional Care01:28

Acute Coronary Syndrome IV: Interprofessional Care

IntroductionThe management of Acute Coronary Syndrome (ACS) aims to minimize myocardial damage, preserve myocardial function, and prevent complications.Initial ManagementInpatient management involves continuous cardiac monitoring, preferably in an ICU, focusing on blood pressure, serum sodium, potassium, and creatinine levels, and urine output. Ongoing pharmacologic management is crucial for stabilizing the patient.Supplemental Oxygen: Administer supplemental oxygen if oxygen saturation is...
Esophageal Varices-II: Clinical Features and Management01:28

Esophageal Varices-II: Clinical Features and Management

Esophageal varices often manifest as gastrointestinal bleeding episodes, presenting symptoms like hematemesis (vomiting of blood), hematochezia (passing fresh blood via the rectum), and melena (black, tarry stools). Other signs can include weight loss, anorexia, abdominal discomfort, jaundice, pruritus, altered mental status, and muscle cramps.
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol abuse, or...