Key result
UGIB during PCI hospitalizations is linked to ~65% higher in-hospital mortality than LGIB.
Why the study?
Gastrointestinal bleeding during PCI hospitalizations worsens outcomes, but national data comparing upper versus lower gastrointestinal bleeding are limited.
Does upper gastrointestinal bleeding compared to lower gastrointestinal bleeding worsen in-hospital mortality and resource utilization in patients undergoing percutaneous coronary intervention?
Observational (n=3,227,805)
Yes
Does upper gastrointestinal bleeding compared to lower gastrointestinal bleeding worsen in-hospital mortality and resource utilization in patients undergoing percutaneous coronary intervention?
Odds Ratio: 1.652 (95% CI 1.29–2.117)
In patients undergoing PCI, upper gastrointestinal bleeding is more frequent than lower gastrointestinal bleeding and is associated with significantly higher in-hospital mortality, length of stay, and costs.
May warrant closer post-PCI monitoring for UGIB; observational data leave causal mechanisms and prevention impact open.
BACKGROUND: Gastrointestinal bleeding (GIB) during a percutaneous coronary intervention (PCI) hospitalization can interrupt antithrombotic therapy and worsen outcomes. National data comparing upper GIB (UGIB) versus lower GIB (LGIB) in PCI hospitalizations are limited. AIMS: To compare incidence, clinical characteristics, and in-hospital outcomes of UGIB versus LGIB events in PCI hospitalizations. METHODS: We analyzed PCI hospitalizations in the 2016-2022 National Inpatient Sample. UGIB and LGIB were identified from site-specific ICD-10-CM diagnosis codes. Hospitalizations with both UGIB and LGIB codes, or with unspecified gastrointestinal hemorrhage (K92.2) without a site-specific code, were excluded. Survey-weighted regression adjusted for demographics, comorbidities, acuity markers, hospital and PCI procedural characteristics. RESULTS: Among 3,227,805 weighted PCI hospitalizations, 41,225 (1.28%) had GIB: 34,215 UGIB-only (83.0%) and 7010 LGIB-only (17.0%). GIB incidence rose from 1.10% to 1.36% (2016-2022), driven by UGIB (0.90% to 1.13%; P < 0.001); LGIB was stable (0.20-0.26%; P = 0.1022). Compared with LGIB, UGIB was independently associated with higher in-hospital mortality (12.35% vs. 6.14%; adjusted odds ratio 1.74, 95% confidence interval 1.36-2.23), longer median stay (7.27 vs. 5.96 days), and higher median cost ($44,712 vs. $36,046; both P < 0.001), with no significant difference in transfusion (P = 0.2134). Excluding variceal-source UGIB did not alter this association. CONCLUSIONS: GIB during PCI hospitalizations was predominantly UGIB, and the rise in incidence was driven by UGIB. UGIB was associated with higher adjusted in-hospital mortality and greater resource utilization than LGIB, suggesting UGIB and LGIB carry different associated mortality risk in this population, though residual confounding cannot be excluded. These findings support attention to upper-GI risk factors and gastroprotection in PCI patients.
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Alnounou et al. (2026) conducted an observational in Percutaneous Coronary Intervention (PCI) hospitalizations with Gastrointestinal Bleeding (n=3,227,805). Upper gastrointestinal bleeding vs. Lower gastrointestinal bleeding was evaluated on In-hospital mortality (OR 1.652, 95% CI 1.290-2.117). Among percutaneous coronary intervention hospitalizations, upper gastrointestinal bleeding was associated with significantly higher odds of in-hospital mortality compared to lower gastrointestinal bleeding (OR 1.652).
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