Temporal trends in gastrointestinal bleeding associated with percutaneous coronary intervention: analysis of the 1998-2006 Nationwide Inpatient Sample (NIS) database

Abstract

Background: Gastrointestinal bleeding (GIB) after percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) and coronary artery disease (CAD) is associated with high morbidity and mortality.

Methods: The NIS database from 1998 to 2006 was used to identify 1,216,759 PCIs performed for ACS and CAD. We sought to analyze temporal trends in the incidence and in-hospital outcomes of GIB associated with PCI along with its predictors.

Results: The overall incidence of GIB was 1.04% (95% confidence interval (CI), 1.02%-1.06%). The incidence of GIB decreased over the study period (P for trend <.0001). The overall mortality in the GIB group was 6.0% (95% CI, 5.6%-6.4%). The adjusted OR for in-hospital mortality and GIB was 4.70 (95% CI, 4.23-5.23; P < .0001); this remained high and essentially unchanged over the study period. Independent predictors of GIB included rectum/anal cancer (OR, 4.64; 95% CI, 3.20-6.73; P < .0001), stomach cancer (OR, 2.74; 95% CI, 1.62-4.66; P = .0002), esophageal cancer (OR, 1.99; 95% CI, 1.08-3.69; P = .0288), colon cancer (OR, 1.69; 95% CI, 1.43-2.02; P < .0001), congestive heart failure (OR, 1.43; 95% CI, 1.35-1.52; P < .0001), and acute myocardial infarction (OR, 1.23; 95% CI, 1.13-1.35; P < .0001).

Conclusions: Although the incidence of GIB associated with PCI decreased from 1998 to 2006 in the face of aggressive therapies for ACS and CAD, the risk of GIB-associated death remained high. Underlying GI malignancy is a significant independent predictor of GIB associated with PCI; identifying these patients may reduce the rate of GIB.

Figure 1

Incidence of gastrointestinal bleeding from 1998 to 2006. The error bars indicate 95% confidence intervals.

Figure 2

Independent predictors for GIB after adjusting for covariates.

Figure 3

Figure 3A. Incidence of in-hospital mortality with gastrointestinal bleeding from 1998 to 2006. The error bars indicate 95% confidence intervals. Figure 3B. Incidence of in-hospital mortality without gastrointestinal bleeding from 1998 to 2006. The error bars indicate 95% confidence intervals.

Figure 3

Figure 3A. Incidence of in-hospital mortality with gastrointestinal bleeding from 1998 to 2006. The error bars indicate 95% confidence intervals. Figure 3B. Incidence of in-hospital mortality without gastrointestinal bleeding from 1998 to 2006. The error bars indicate 95% confidence intervals.