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

摘要

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.