According to researchers at Kaiser Permanente Los Angeles Medical Canter in Los Angeles, upper gastrointestinal hemorrhage (GIB) is a significant complication of percutaneous coronary intervention (PCI), one associated with increased mortality compared with lower GIB.
As described in a study presented at DDW 2013, held in May 2013 in Orlando, they analyzed data from the 2008 Nationwide Inpatient Sample (NIS), covering 1051 hospitals in 45 states. Out of 644,657 admissions for acute myocardial infarction (MI), 184,436 (28.6%) patients received PCI with either non-drug eluting or drug-eluting stents. The mean age was 76. Men compromised the majority of the cohort, 98,304 (53.3%). Of the percutaneous coronary stenting (PCS) cohort, 3688 patients (2%) developed gastrointestinal hemorrhage: upper GIB in 969 patients (26.3%), lower GIB in 829 (22.5%), and GIB NOS in 1888 (51.2%). (Patients with unspecified gastrointestinal hemorrhage that could not be classified as upper or lower source were excluded from subsequent analyses.)
According to the researchers, multivariable logistic regression revealed upper GIB to be an independent risk factor for increased mortality (odds ratio [OR] 1.244; confidence interval [CI], 1.041 to 1.487) after adjusting for age, gender, and AHRQ mortality risk index. Among patients that developed upper GIB, the majority were ulcer related (54.8%). However, non-ulcer upper GIB, including variceal hemorrhage, was associated with increased mortality in multivariate analysis (OR 1.589; CI, 1.266 to 1.994).