Key result
Gastrointestinal bleeding after primary PCI for STEMI was associated with higher overall mortality and longer intensive care unit stays.
Why the study?
What are the predictors of gastrointestinal bleeding and its impact on outcomes in STEMI patients undergoing primary percutaneous coronary intervention?
Observational (n=519)
What are the predictors of gastrointestinal bleeding and its impact on outcomes in STEMI patients undergoing primary percutaneous coronary intervention?
Gastrointestinal bleeding is a rare but severe complication after primary PCI for STEMI, associated with significantly increased mortality, especially in patients with prior GI bleeding, impaired renal function, or Killip class IV presentation.
Answers are grounded in this paper and cite their sources.
Warrants heightened vigilance for GI bleeding post-PCI in STEMI; leaves open whether targeted prevention improves outcomes in high-risk subgroups.
BACKGROUND: Gastrointestinal bleeding is a hemorrhagic complication after primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction (STEMI). OBJECTIVES: To determine predictors of gastrointestinal bleeding and the impact of gastrointestinal bleeding on outcomes in STEMI patients undergoing primary percutaneous coronary intervention. METHODS AND RESULTS: Gastrointestinal bleeding occurred in 18 (3.5%) of 519 consecutive patients with STEMI undergoing primary percutaneous coronary intervention. Univariate predictors of gastrointestinal bleeding were previous gastrointestinal bleeding (33% vs 4%, P < .001), impaired renal function (89% vs 37%, P<.001), Killip class IV at presentation (61% vs 18%, P<.001), higher peak creatinine kinase level (mean [SD], 3801.6 [3280.2] vs 2721.3 [2286.6] IU/L, P=.05), and mechanical ventilator support (44% vs 12%, P<.001). Coprescription of proton-pump inhibitors did not reduce the risk of gastrointestinal bleeding (22.2% vs 13.4%, P=.22). Multivariate analysis showed an odds ratio (95% confidence interval) for gastrointestinal bleeding of 22.1 (5.6-86.89, P<.001) for previous gastrointestinal bleeding, 6.74 (1.30-34.89, P=.02) for impaired renal function, and 4.68 (1.35-16.2, P=.01) for Killip class IV at presentation. Gastrointestinal bleeding was associated with longer intensive care unit stay (mean [SD], 5.4 [6.7] vs 3.6 [3.6] days, P=.04), and higher in-hospital (44% vs 9%, P<.001) and overall (44% vs 13%, P<.001) mortality rate. CONCLUSIONS: Although rare, gastrointestinal bleeding in patients with STEMI significantly prolongs intensive care unit stay and increases mortality. Previous gastrointestinal bleeding, impaired renal function, and Killip class IV at presentation are associated with higher incidence of gastrointestinal bleeding.
No takes yet. Share an insight, caveat, or question.
Chua et al. (2011) conducted an observational in ST-segment elevation myocardial infarction (STEMI) (n=519). Gastrointestinal bleeding vs. No gastrointestinal bleeding was evaluated on Overall mortality (p=<.001). Gastrointestinal bleeding after primary PCI for STEMI was associated with higher overall mortality and longer intensive care unit stays.
Synapse has enriched 10 related papers. Consider them for comparative context: