Background: Hemorrhagic complications of acute coronary syndromes and percutaneous coronary intervention (PCI) are associated with increased mortality. Upper gastrointestinal (UGI) bleeding after PCI is a potential target for preventative strategies.
Objective: To evaluate the risk factors for UGI bleeding in a large cohort of contemporary PCI patients and assess the outcomes of medical and endoscopic management.
Method: A case-control study evaluating UGI bleeding in the 30 days following PCI for stable angina and acute coronary syndromes, at one institution between 1998 and 2005. Cases were identified and outcomes assessed using linkage analysis of data from institutional PCI and endoscopy databases, statewide vital statistics and hospital discharge registries, and a detailed review of medical notes for each case and three matched controls. Analysis of the case and control groups for risk and protective factors was performed using the chi2 test with Fisher's exact P value and logistic regression.
Results: The incidence of UGI bleeding following PCI was 1.2% (70 of 5,673 patients). The etiologies of these bleeds were diverse. Risk factors for UGI bleeding were primary PCI (OR 27.80, 95% CI 6.28-123.05, P < 0.001), cardiac arrest (OR 6.17, 95% CI 1.82-20.84, P= 0.003), inotropic requirement (OR 5.85, 95% CI 1.98-17.27, P= 0.001), thienopyridine use before PCI (OR 2.40, 95% CI 1.04-5.53, P= 0.02), and advanced age (OR 1.08, 95% CI 1.04-1.12, P < 0.001). Proton pump inhibitor use after PCI (OR 0.08, 95% CI 0.02-0.40, P= 0.002) was accompanied by a reduced risk of UGI bleeding. Endoscopy provided therapeutic intervention in 33% of patients. There were no serious complications of endoscopy. The 30-day mortality for cases was 11.9% and 0.5% for controls (P= 0.001).
Conclusion: UGI bleeding after PCI is relatively common and associated with increased mortality. Those undergoing PCI for acute myocardial infarction or in the presence hemodynamic instability are at highest risk. Proton pump inhibition following PCI may reduce the bleeding risk, though when UGI bleeding occurs, therapeutic endoscopy is safe.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1111/j.1572-0241.2007.01460.x | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Image-enhanced endoscopy in upper gastrointestinal disease: focusing on texture and color enhancement imaging and red dichromatic imaging.
Clin Endosc
November 2024
Division of Gastroenterology, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea.
Endoscopic examination plays a crucial role in the diagnosis of upper gastrointestinal (UGI) tract diseases. Despite advancements in endoscopic imaging, the detection of subtle early cancers and premalignant lesions using white-light imaging alone remains challenging. This review discusses two novel image-enhanced endoscopy (IEE) techniques-texture and color enhancement imaging (TXI) and red dichromatic imaging (RDI)-and their potential applications in UGI diseases.
View Article and Find Full Text PDFSudden-onset gastrointestinal bleeding in a young adult: diagnostic and therapeutic challenges of a Dieulafoy's lesion in the jejunum.
Surg Case Rep
November 2024
Institute of Surgical Gastroenterology, GI & HPB Oncosurgery and Liver Transplant, Sir Ganga Ram Hospital, New Delhi, India.
Background: A Dieulafoy's lesion in the jejunum is at an uncommon site but may be the cause of massive gastrointestinal bleeding. It is characterized by a large, tortuous submucosal artery that erodes the overlying epithelium and presents diagnostic and therapeutic challenges due to its atypical location and presentation.
Case: A 30-year-old male presented with sudden onset syncope and the passage of 200-300 ml of red blood-mixed stool.
Low molecular weight heparin use and thrombotic complications in upper gastrointestinal resection for malignancy in a multi-ethnic Asian population.
Asian J Surg
October 2023
University Surgical Cluster, National University Hospital, Singapore; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Article Synopsis
- The study examines the impact of low molecular weight heparin (LMWH) on venous thromboembolic (VTE) and bleeding events in Asian patients after major surgery for upper gastrointestinal malignancies.
- It included data from 399 patients over a decade in Singapore, finding that while LMWH did not significantly reduce VTE incidents, it was linked to a higher rate of postoperative bleeding.
- The conclusion suggests that routine use of LMWH is not recommended for Asian patients undergoing these surgical procedures due to the increased risk of bleeding without substantial benefits in VTE prevention.
Clinical and Endoscopic Findings in Patients Presenting with Upper Gastrointestinal Bleeding at a Tertiary Care Hospital.
Kathmandu Univ Med J (KUMJ)
September 2024
Department of Internal Medicine, Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal.
Background Upper gastrointestinal (UGI) bleeding is a severe medical condition that requires prompt evaluation and management. Understanding the clinical and endoscopic findings in patients presenting with upper gastrointestinal bleeding is essential for accurate diagnosis and effective treatment. Objective To investigate the age and sex composition, clinical presentations, and endoscopic findings of patients with upper gastrointestinal bleeding at a tertiary care hospital.
View Article and Find Full Text PDFUpper Gastrointestinal Endoscopic Findings and Their Clinical Correlates in Patients With Liver Cirrhosis in Northern Ghana.
Cureus
August 2024
Internal Medicine/Cardiology, Kwame Nkrumah University of Science and Technology, Kumasi, GHA.
Article Synopsis
- This study looked at patients with liver cirrhosis at a hospital in Ghana to understand how the disease affects their stomach and esophagus.
- They found that many patients had symptoms like tiredness and swelling, with most being older men in a severe stage of the disease.
- The most common issue spotted during examinations was esophageal varices, which are bulging veins related to the condition, along with other stomach problems.
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!