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GI bleeding complicating PCI: Trends, outcomes, and a paradoxical decline in endoscopy utilization

Adrian Nubla1, Keerthana Manjunath1, Marco Dispagna1

  • 1Department of Medicine, Cook County Health, Chicago, IL, USA.

Cardiovascular Revascularization Medicine : Including Molecular Interventions
|August 19, 2026
PubMed

Insights

Gastrointestinal bleeding (GIB) after percutaneous coronary intervention (PCI) affects about 2.1% of patients, increasing mortality and costs. Declining endoscopy use despite its benefits presents a quality improvement opportunity.

Area of Science:

  • Cardiology
  • Gastroenterology
  • Health Services Research

Background:

  • Gastrointestinal bleeding (GIB) is a serious complication of percutaneous coronary intervention (PCI).
  • Updated national data on GIB trends, management, and outcomes are needed.
  • Patient subgroups require specific analysis regarding GIB risk and outcomes.

Purpose of the Study:

  • To analyze national trends in GIB prevalence, management, and outcomes following PCI.
  • To identify risk factors and disparities in GIB occurrence and mortality.
  • To evaluate the impact of endoscopy utilization on GIB outcomes.

Main Methods:

  • Analysis of the National Inpatient Sample (2016-2022) for PCI admissions with GIB.
  • Survey-weighted multivariable logistic regression and inverse probability of treatment weighting (IPTW) for adjusted analyses.
  • Assessment of temporal trends in GIB prevalence, subtype, endoscopy use, and transfusion rates.

Main Results:

  • GIB occurred in approximately 2.1% of 3.2 million PCI admissions.
  • GIB was associated with significantly higher in-hospital mortality (aOR 3.393), longer hospital stays, and increased costs.
  • Despite stable prevalence, upper endoscopy use declined (OR 0.959/year) but was linked to lower mortality (aOR 0.702).
  • Black and Hispanic patients exhibited higher odds of GIB.

Conclusions:

  • GIB significantly increases mortality, hospitalization duration, and costs post-PCI.
  • Declining endoscopy use, despite its survival benefit, indicates a potential quality improvement area.
  • Lower GIB is associated with higher mortality, necessitating further research.
Abstract

Keywords:
Endoscopy utilizationGastrointestinal bleedingIn-hospital mortalityNational inpatient samplePercutaneous coronary interventionRacial disparities

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