Gastrointestinal Bleeding Is Associated with Worse In-Hospital Outcomes in Patients with ST-Segment Elevation Myocardial Infarction: An Analysis of the National Inpatient Sample

Background/Objectives: Patients with ST-segment elevation myocardial infarction (STEMI) may develop gastrointestinal (GI) bleeding. We aimed to assess the impact of GI bleeding on in-hospital outcomes in patients with STEMI. Methods: This retrospective study was performed using the National Inpatient Sample from the United States of America from the years 2016–2021 to identify STEMI hospitalizations. Index admissions were stratified according to concomitant GI bleeding. The primary outcome was in-hospital mortality; secondary outcomes were inflation-adjusted total charges, total costs, length of stay ≥7 days, acute kidney injury, and cardiogenic shock. Multivariable analysis with a logistic regression model was used to identify associations with in-hospital mortality and several secondary outcomes. Results: Of 1,013,800 index admissions with STEMI, 22,260 (2.2%) had concomitant GI bleeding. Patients with GI bleeding were older and more frequently had comorbidities such as chronic heart failure, liver disease, and chronic kidney disease. In-hospital mortality was higher in patients with GI bleeding (27.8% versus 7.6%, p < 0.001). GI bleeding was associated with 2.30 times (2.11–2.51, p < 0.001), 3.78 times (3.50–4.07, p < 0.001), 2.99 times (2.76–3.24, p < 0.001), and 2.62 times (2.42–2.83, p < 0.001) increased odds of in-hospital mortality, length of stay ≥7 days, acute kidney injury, and cardiogenic shock, respectively. However, liver disease was most strongly positively associated with in-hospital mortality (odds ratio [OR]: 5.50 [5.21–5.80], p < 0.001), acute kidney injury (OR: 6.50 [6.18–6.84], p < 0.001), and cardiogenic shock (OR: 5.47 [5.22–5.74], p < 0.001). Conclusions: GI bleeding was associated with in-hospital mortality, adverse outcomes, and increased resource utilization in patients with STEMI, highlighting the need for risk stratification, implementation of preventative strategies, and timely treatment of GI bleeding.