Related Experiment Video
Updated: Jul 19, 2025
Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
Validation of prediction tools for GI bleeding in patients on dual anti-platelet therapy after percutaneous coronary
Pedro Cortés1, Jennifer J Zeng2, Christian Karime1
1Division of Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA.
Insights
Predicting gastrointestinal bleeding (GIB) after percutaneous coronary intervention (PCI) is crucial. A new SIGE score effectively predicts recurrent bleeding, which increases the risk of major adverse cardiovascular events (MACEs).
Area of Science:
- Cardiology
- Gastroenterology
- Clinical Pharmacology
Background:
- Dual anti-platelet therapy management after percutaneous coronary intervention (PCI) and gastrointestinal bleeding (GIB) presents a clinical challenge.
- Identifying predictors of GIB and recurrent bleeding is essential for patient management.
- Understanding the link between recurrent bleeding and major adverse cardiovascular events (MACEs) is critical.
Purpose of the Study:
- To identify predictors of GIB and recurrent bleeding in patients undergoing PCI.
- To determine if recurrent bleeding increases the risk of MACEs.
- To develop a novel risk score for predicting recurrent bleeding.
Main Methods:
- Single-center retrospective study of 536 patients undergoing PCI.
- Logistic regression to identify predictors of GIB and recurrent bleeding.
- Cox proportional hazards modeling to assess the predictive value of recurrent bleeding for MACEs.
- Development and validation of the SIGE score for recurrent bleeding prediction.
Main Results:
- PCI for acute coronary syndrome was associated with a 95% increased odds of GIB.
- The HAS-BLED score, including labile INR and prior major bleeding, strongly predicted recurrent bleeding.
- Recurrent bleeding was linked to a 115% increased risk of MACEs.
- The novel SIGE score demonstrated high predictive accuracy (AUC, 0.773) for recurrent bleeding.
Conclusions:
- The SIGE score shows promise in predicting recurrent bleeding after PCI.
- Recurrent bleeding is a significant risk factor for MACEs.
- Further external validation of the SIGE score is recommended.
Background And Aims:
The management of dual anti-platelet therapy after percutaneous coronary intervention (PCI) and GI bleeding (GIB) remains a clinical dilemma. We sought to identify predictors of GIB and recurrent bleeding and to determine whether recurrent bleeding increases the risk of major adverse cardiovascular events (MACEs).
Methods:
In this single-center retrospective study, patients undergoing PCI were identified. The primary and secondary endpoints were GIB at 180 days and recurrent bleeding or MACE at 365 days. Logistic regression was used to identify predictors of GIB and recurrent bleeding. Cox proportional hazards modeling was used to determine whether recurrent bleeding can predict a MACE.
Results:
Five hundred thirty-six patients were included. On multivariable analysis, PCI for acute coronary syndrome was associated with a 95% increased odds of GIB (P < .001). The P2Y12 inhibitor was continued in >90% of patients, which trended toward significance for recurrent bleeding (P < .10). The HAS-BLED score (Hypertension, Abnormal renal and liver function, Stroke, Bleeding tendency or predisposition, Labile INRs, Elderly, Drugs), including a labile international normalized ratio and prior major bleeding, was strongly associated with recurrent bleeding (P ≤ .009). Recurrent bleeding was associated with a 115% increased risk of MACEs (P = .02). We derived a novel risk score, named the SIGE score ([S]TEMI at PCI, having a labile [I]NR at PCI, index [G]IB within 180 days of PCI, and previous precatheterization [E]ndoscopy within 6 months), to predict recurrent bleeding at 365 days with a high predictive accuracy (area under the curve, .773; 95% confidence interval, .702-.845).
Conclusions:
The SIGE score may help to predict recurrent bleeding, which was shown to be associated with an increased risk of MACEs. Further external validation is needed.
Related Concept Videos
01:20Antiplatelet Drugs: Prostaglandin Synthesis, P2Y12 and Glycoprotein IIb/IIIa Inhibitors
Prostaglandin synthesis inhibitors, exemplified by the widely known aspirin, wield their power by irreversibly acetylating...
01:27Coronary Artery Disease V: Interprofessional Care
01:27Peripheral Artery Disease III: Interprofessional Care
01:29Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
01:26Peptic Ulcer Disease IV: Management
The therapeutic approach involves ensuring adequate rest, implementing drug therapy, promoting smoking cessation, making dietary modifications, and emphasizing long-term follow-up care.
Pharmacological management
The prevailing therapy for peptic ulcers involves a combination of managing the patient's current...
01:29Venous Thrombosis III: Interprofessional Care