Post written by Mohammad Bilal, MD, from the Division of Gastroenterology & Hepatology, The University of Texas Medical Branch, Galveston, Texas, and the Division of Gastroenterology & Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
Coronary artery disease is the leading cause of mortality in the United States, and acute myocardial infarction is the most feared adverse event of coronary artery disease and presents as either ST-elevation myocardial infarction (STEMI) or non-ST-elevation myocardial infarction (NSTEMI). Percutaneous coronary intervention (PCI) is now the gold standard for the treatment of acute myocardial infarction and is the most common invasive cardiac procedure in the United States. This in turn leads to more patients being on dual anti-platelet therapy (DAPT). The risk of gastrointestinal bleeding, especially non-variceal upper gastrointestinal hemorrhage (NVUGIH), is increased in patients on dual anti-platelet therapy. For patients who undergo PCI, DAPT is usually recommended for 1 year; we aimed to determine the incidence of NVUGIH after PCI in patients with acute myocardial infarction over 11 months and its impact on outcomes.
The majority of prior studies report rates of GI bleeding within 30 days of PCI, and since DAPT is usually continued for 12 months in the majority of patients with acute myocardial infarction who undergo PCI, we felt it was important to provide an estimate of GI bleeding rates over a year.
Our results showed that in acute mycordial infarction patients who underwent PCI, the incidence of NVUGIH over 11 months is 1.6%. In patients who develop NVUGIH, the outcomes including mortality, rates of endoscopy, and need for prolonged mechanical ventilation are worse. In addition, NVUGIH adds significant burden to healthcare resource utilization.
Despite the limitations to our study, the majority of which are inherent to the use of an administrative database, our study provides important epidemiological data regarding 11-month rates of NVUGIH and outcomes in patients post-PCI for acute myocardial infarction.
Figure 3. Time from discharge to readmission for patients with acute coronary syndrome who developed nonvariceal upper GI hemorrhage (NVUGIH) after a percutaneous coronary intervention. More than 50% of patients who developed NVUGIH after a percutaneous coronary intervention did so within 90 days of discharge.
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