Gastrointestinal bleeding in patients undergoing primary angioplasty for acute myocardial infarction: incidence, risk factors and prognosis

OBJECTIVES
We investigated the incidence, predictors, and prognosis of gastrointestinal bleeding (GIB) in patients undergoing primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI).

STUDY DESIGN
We reviewed 2,541 consecutive patients (2,111 males, 430 females; mean age 56.5±11.8 years) who underwent primary PCI for STEMI. Data on clinical, angiographic findings, and in-hospital outcomes were collected. Gastrointestinal bleeding was defined as apparent upper or lower GIB or melena requiring cessation of antiplatelet or anticoagulant therapy and administration of erythrocyte infusion.

RESULTS
Gastrointestinal bleeding was observed in 27 patients (1.1%). Compared to 2,514 patients without GIB, patients with GIB were older (65.9±13.5 years vs. 56.4±11.8 years; p<0.001), exhibited higher frequencies of female gender (p=0.016), renal failure (p<0.001), and admission anemia (p<0.001), and had a lower procedural success rate (77.9% vs. 91.5%; p=0.02). The development of GIB was associated with significantly higher in-hospital mortality (18.5% vs. 2.9%; p<0.001), longer hospital stay (13.1±6.8 days vs. 7.0±3.7 days, p=0.02), and increased inotropic requirement (37% vs. 6.7%; p<0.001). In multivariate analysis, inotropic requirement (OR 4.17, 95% CI 1.7-10.4; p=0.002), age above 70 years (OR 3.33, 95% CI 1.4-8.0; p=0.007), and glomerular filtration rate lower than 60 ml/min/1.73 m2 (OR 2.96, 95% CI 1.2-7.4; p=0.02) were independent predictors of in-hospital GIB.

CONCLUSION
The development of GIB is not an uncommon complication after primary PCI for STEMI. These patients have a prolonged hospital stay and increased in-hospital mortality. Increased inotropic requirement, age above 70 years, and impaired renal function are independent predictors of this complication.