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Gastrointestinal Bleeding Is Associated with Worse In-Hospital Outcomes in Patients with ST-Segment Elevation
Shreyas Ranganath1, Trishna Parikh2, Adishwar Rao3
1McGovern Medical School at the University of Texas Health Science Center at Houston, 6431 Fannin St., Houston, TX 77030, USA.
Abstract:
Background/Objectives: Patients with ST-segment elevation myocardial infarction (STEMI) may develop gastrointestinal (GI) bleeding. We aimed to assess the impact of GI bleeding on in-hospital outcomes in patients with STEMI. Methods: This retrospective study was performed using the National Inpatient Sample from the United States of America from the years 2016-2021 to identify STEMI hospitalizations. Index admissions were stratified according to concomitant GI bleeding. The primary outcome was in-hospital mortality; secondary outcomes were inflation-adjusted total charges, total costs, length of stay ≥7 days, acute kidney injury, and cardiogenic shock. Multivariable analysis with a logistic regression model was used to identify associations with in-hospital mortality and several secondary outcomes. Results: Of 1,013,800 index admissions with STEMI, 22,260 (2.2%) had concomitant GI bleeding. Patients with GI bleeding were older and more frequently had comorbidities such as chronic heart failure, liver disease, and chronic kidney disease. In-hospital mortality was higher in patients with GI bleeding (27.8% versus 7.6%, p < 0.001). GI bleeding was associated with 2.30 times (2.11-2.51, p < 0.001), 3.78 times (3.50-4.07, p < 0.001), 2.99 times (2.76-3.24, p < 0.001), and 2.62 times (2.42-2.83, p < 0.001) increased odds of in-hospital mortality, length of stay ≥7 days, acute kidney injury, and cardiogenic shock, respectively. However, liver disease was most strongly positively associated with in-hospital mortality (odds ratio [OR]: 5.50 [5.21-5.80], p < 0.001), acute kidney injury (OR: 6.50 [6.18-6.84], p < 0.001), and cardiogenic shock (OR: 5.47 [5.22-5.74], p < 0.001). Conclusions: GI bleeding was associated with in-hospital mortality, adverse outcomes, and increased resource utilization in patients with STEMI, highlighting the need for risk stratification, implementation of preventative strategies, and timely treatment of GI bleeding.
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