title: Incidence, predictors and outcome of upper gastrointestinal bleeding in patients with acute coronary syndromes.
abstract: BACKGROUND
  The broad utilization of revascularization and antithrombotic therapy in patients with acute coronary syndrome (ACS) is associated with a substantial risk of bleeding primarily related to arterial punctures, which can lead to worse outcome.
  
  
  OBJECTIVE
  To define the characteristics and outcome of patients who develop upper gastrointestinal bleeding (UGIB) in the setting of ACS.
  
  
  METHODS
  We identified all patients admitted to the coronary care unit between 10/96 and 11/07 with ACS who developed UGIB. For each case 3 control cases were matched. Multiple baseline characteristics, as well as antithrombotic agents, revascularization strategy and endoscopy reports were assessed. Mortality at 30-day was the primary endpoint of the analysis.
  
  
  RESULTS
  Of 7240 ACS patients, 64 (0.9%) developed UGIB. There were no significant differences between groups in the prevalence of diabetes and other risk factors, revascularization strategy, or the use of proton pump inhibitors. Patients with UGIB suffered more from renal impairment and left ventricular dysfunction and were more frequently treated with thienopyridines (89% vs. 68%, p=0.002) and glycoprotein IIb/IIIa inhibitors (39% vs. 24%, p=0.03). The combination of unfractionated heparin (UFH) with glycoprotein IIb/IIIa inhibitors was strongly associated with UGIB (OR: 2.87, 95% CI 1.66-4.97). Patients who developed UGIB had a substantially higher 30-day mortality rate (33% vs. 5%, p<0.001).
  
  
  CONCLUSIONS
  UGIB in patients with ACS is associated with a markedly increased mortality. Previous peptic disease and the use of combined anti-platelet therapy, especially in conjunction with heparin, are strong risk factors for this serious complication.
authors.affiliation: Department of Cardiology, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Be'er Sheva, Israel. ary.shalev@gmail.com
authors.forename: Aryeh
authors.initials: A
authors.lastname: Shalev
authors.forename: Doron
authors.initials: D
authors.lastname: Zahger
authors.forename: Victor
authors.initials: V
authors.lastname: Novack
authors.forename: Ohad
authors.initials: O
authors.lastname: Etzion
authors.forename: Avi
authors.initials: A
authors.lastname: Shimony
authors.forename: Harel
authors.initials: H
authors.lastname: Gilutz
authors.forename: Carlos
authors.initials: C
authors.lastname: Cafri
authors.forename: Reuben
authors.initials: R
authors.lastname: Ilia
authors.forename: Alexander
authors.initials: A
authors.lastname: Fich
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology*; D000368:Aged; D016022:Case-Control Studies; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis* / Q000453:epidemiology* / Q000209:etiology; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D041742:Upper Gastrointestinal Tract / Q000473:pathology*
chemical_list: D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex