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Predictors and prognostic consequence of gastrointestinal bleeding in patients with ST-segment elevation myocardial infarction.

Abstract：

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.

journal_name

Int J Cardiol

journal_title

International journal of cardiology

authors

Kikkert WJ,Hassell MECJ,Delewi R,van der Laan MH,Baan J Jr,Vis MM,Koch KT,de Winter RJ,Piek JJ,Tijssen JGP,Henriques JPS

doi

10.1016/j.ijcard.2015.01.041

subject

Has Abstract

pub_date

2015-04-01 00:00:00

pages

128-134

eissn

0167-5273

issn

1874-1754

pii

S0167-5273(15)00068-6

journal_volume

184

pub_type

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Predictors and prognostic consequence of gastrointestinal bleeding in patients with ST-segment elevation myocardial infarction.