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Predictors and prognostic consequence of gastrointestinal bleeding in patients with ST-segment elevation myocardial
Wouter J Kikkert1, Mariëlla E C J Hassell1, Ronak Delewi1
1Department of Cardiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
Insights
Gastrointestinal bleeding is a significant risk for ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention. While not increasing cardiac events, GI bleeding risk doubles after a first occurrence, highlighting the need for careful management.
Area of Science:
- Cardiology
- Gastroenterology
- Interventional Cardiology
Background:
- Limited data exist on gastrointestinal (GI) bleeding predictors and outcomes in ST-elevation myocardial infarction (STEMI) patients receiving primary percutaneous coronary intervention (PPCI) and dual antiplatelet therapy.
- Understanding these factors is crucial for managing STEMI patients who are at risk for bleeding complications.
Purpose of the Study:
- To identify predictors of GI bleeding in STEMI patients treated with PPCI.
- To assess the clinical outcomes and long-term implications of GI bleeding in this patient population.
- To evaluate the association between GI bleeding and subsequent ischemic events or mortality.
Main Methods:
- A cohort of 2002 STEMI patients undergoing PPCI between January 2003 and July 2008 were analyzed.
- Data on GI bleeding, patient characteristics, and clinical outcomes were collected during a median follow-up of 4.9 years.
- Multivariable analysis was used to determine predictors of GI bleeding and its association with adverse events.
Main Results:
- 139 patients experienced GI bleeding. Key predictors included advanced age, history of bleeding, anemia, thrombocytopenia, prior coronary artery bypass grafting, cardiogenic shock, anterior infarction, and GP IIb/IIIa inhibitor use.
- A first episode of GI bleeding was associated with a more than twofold increased risk of subsequent GI bleeding (HR 2.19).
- GI bleeding was not significantly associated with increased risks of major adverse cardiac events, cardiac mortality, all-cause mortality, recurrent myocardial infarction, stroke, or stent thrombosis.
Conclusions:
- In STEMI patients undergoing PPCI, risk factors for GI bleeding include advanced age, prior bleeding history, anemia, anterior infarction, and GP IIb/IIIa inhibitor use.
- GI bleeding does not substantially increase the risk of subsequent ischemic events in this population.
- The risk of experiencing another GI bleed is more than doubled after a first occurrence, emphasizing the importance of preventative strategies.
Background:
Limited data are available on the predictors and implications of gastrointestinal (GI) bleeding in ST-segment elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (PPCI) and dual antiplatelet therapy.
Methods And Results:
Predictors of and clinical outcome after GI bleeding were assessed in 2002 STEMI patients undergoing PPCI between 1-1-2003 and 31-07-2008. 139 patients suffered GI bleeding during a median follow-up of 4.9 years. Predictors of GI bleeding were age, history of bleeding, anemia, baseline thrombocytopenia, previous coronary artery bypass grafting, cardiogenic shock, anterior infarction and the use of GP IIb/IIIa inhibitor. By multivariable analysis, a first occurrence of GI bleeding was associated with a twofold increase in risk of subsequent GI bleeding (hazard ratio (HR) 2.19; 95% confidence interval (CI) 1.15-4.17). GI bleeding was not significantly associated with subsequent major adverse cardiac events (HR 1.33; 95% CI 0.98-1.79), cardiac (HR 1.40; 95% CI 0.97-2.02) and all-cause mortality (HR 1.34; 95% CI 0.96-1.85), recurrent MI (HR 0.97; 95% CI 0.58-1.63), stroke (HR 1.26; 95% CI 0.57-2.79) or stent thrombosis (HR 0.71; 95% CI 0.33-1.69).
Conclusion:
Among STEMI patients undergoing PPCI, the risk of GI bleeding is related to a number of risk factors, including advanced age, previous (GI) bleeding, GP IIB/IIIA inhibitors, anterior infarction and anemia. GI bleeding does not substantially increase the risk of subsequent recurrent ischemic events in STEMI patients undergoing PPCI, whereas the risk of GI bleeding after a first occurrence is more than doubled.
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