title: Clinical impact of gastrointestinal bleeding in patients undergoing percutaneous coronary interventions.
abstract: BACKGROUND
  The risk factors and clinical sequelae of gastrointestinal bleeding (GIB) in the current era of drug-eluting stents, prolonged dual antiplatelet therapy, and potent P2Y12 inhibitors are not well established. We determined the frequency, predictors, and clinical impact of GIB after percutaneous coronary interventions (PCIs) in a contemporary cohort of consecutive patients treated with unrestricted use of drug-eluting stents.
  
  
  RESULTS
  Between 2009 and 2012, all consecutive patients undergoing PCI were prospectively included in the Bern PCI Registry. Bleeding Academic Research Consortium (BARC) GIB and cardiovascular outcomes were recorded within 1 year of follow-up. Among 6212 patients, 84.1% received new-generation drug-eluting stents and 19.5% received prasugrel. At 1 year, GIB had occurred in 65 patients (1.04%); 70.8% of all events and 84.4% of BARC ≥ 3B events were recorded > 30 days after PCI. The majority of events (64.4%) were related to upper GIB with a more delayed time course compared with lower GIB. Increasing age, previous GIB, history of malignancy, smoking, and triple antithrombotic therapy (ie, oral anticoagulation plus dual antiplatelet therapy) were independent predictors of GIB in multivariable analysis. GIB was associated with increased all-cause mortality (adjusted hazard ratio, 3.40; 95% confidence interval, 1.67-6.92; P = 0.001) and the composite of death, myocardial infarction, or stroke (adjusted hazard ratio, 3.75; 95% confidence interval, 1.99-7.07; P < 0.001) and was an independent predictor of all-cause mortality during 1 year.
  
  
  CONCLUSIONS
  Among unselected patients undergoing PCI, GIB has a profound effect on prognosis. Triple antithrombotic therapy emerged as the single drug-related predictor of GIB in addition to patient-related risk factors within 1 year of PCI.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT02241291.
authors.affiliation: From the Department of Cardiology, Bern University Hospital, Bern, Switzerland (K.C.K., L.R., T.Z., P.W., S.S., A.M., A.A.K., T.P., S.B., C.M., B.M., S.W.); and Institute of Primary Health Care (P.J.), Institute of Social and Preventive Medicine (D.H.), and Clinical Trials Unit, Department of Clinical Research (S.W.), University of Bern, Bern, Switzerland.
authors.forename: Konstantinos C
authors.initials: KC
authors.lastname: Koskinas
authors.affiliation: From the Department of Cardiology, Bern University Hospital, Bern, Switzerland (K.C.K., L.R., T.Z., P.W., S.S., A.M., A.A.K., T.P., S.B., C.M., B.M., S.W.); and Institute of Primary Health Care (P.J.), Institute of Social and Preventive Medicine (D.H.), and Clinical Trials Unit, Department of Clinical Research (S.W.), University of Bern, Bern, Switzerland.
authors.forename: Lorenz
authors.initials: L
authors.lastname: Räber
authors.affiliation: From the Department of Cardiology, Bern University Hospital, Bern, Switzerland (K.C.K., L.R., T.Z., P.W., S.S., A.M., A.A.K., T.P., S.B., C.M., B.M., S.W.); and Institute of Primary Health Care (P.J.), Institute of Social and Preventive Medicine (D.H.), and Clinical Trials Unit, Department of Clinical Research (S.W.), University of Bern, Bern, Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Zanchin
authors.affiliation: From the Department of Cardiology, Bern University Hospital, Bern, Switzerland (K.C.K., L.R., T.Z., P.W., S.S., A.M., A.A.K., T.P., S.B., C.M., B.M., S.W.); and Institute of Primary Health Care (P.J.), Institute of Social and Preventive Medicine (D.H.), and Clinical Trials Unit, Department of Clinical Research (S.W.), University of Bern, Bern, Switzerland.
authors.forename: Peter
authors.initials: P
authors.lastname: Wenaweser
authors.affiliation: From the Department of Cardiology, Bern University Hospital, Bern, Switzerland (K.C.K., L.R., T.Z., P.W., S.S., A.M., A.A.K., T.P., S.B., C.M., B.M., S.W.); and Institute of Primary Health Care (P.J.), Institute of Social and Preventive Medicine (D.H.), and Clinical Trials Unit, Department of Clinical Research (S.W.), University of Bern, Bern, Switzerland.
authors.forename: Stefan
authors.initials: S
authors.lastname: Stortecky
authors.affiliation: From the Department of Cardiology, Bern University Hospital, Bern, Switzerland (K.C.K., L.R., T.Z., P.W., S.S., A.M., A.A.K., T.P., S.B., C.M., B.M., S.W.); and Institute of Primary Health Care (P.J.), Institute of Social and Preventive Medicine (D.H.), and Clinical Trials Unit, Department of Clinical Research (S.W.), University of Bern, Bern, Switzerland.
authors.forename: Aris
authors.initials: A
authors.lastname: Moschovitis
authors.affiliation: From the Department of Cardiology, Bern University Hospital, Bern, Switzerland (K.C.K., L.R., T.Z., P.W., S.S., A.M., A.A.K., T.P., S.B., C.M., B.M., S.W.); and Institute of Primary Health Care (P.J.), Institute of Social and Preventive Medicine (D.H.), and Clinical Trials Unit, Department of Clinical Research (S.W.), University of Bern, Bern, Switzerland.
authors.forename: Ahmed A
authors.initials: AA
authors.lastname: Khattab
authors.affiliation: From the Department of Cardiology, Bern University Hospital, Bern, Switzerland (K.C.K., L.R., T.Z., P.W., S.S., A.M., A.A.K., T.P., S.B., C.M., B.M., S.W.); and Institute of Primary Health Care (P.J.), Institute of Social and Preventive Medicine (D.H.), and Clinical Trials Unit, Department of Clinical Research (S.W.), University of Bern, Bern, Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Pilgrim
authors.affiliation: From the Department of Cardiology, Bern University Hospital, Bern, Switzerland (K.C.K., L.R., T.Z., P.W., S.S., A.M., A.A.K., T.P., S.B., C.M., B.M., S.W.); and Institute of Primary Health Care (P.J.), Institute of Social and Preventive Medicine (D.H.), and Clinical Trials Unit, Department of Clinical Research (S.W.), University of Bern, Bern, Switzerland.
authors.forename: Stefan
authors.initials: S
authors.lastname: Blöchlinger
authors.affiliation: From the Department of Cardiology, Bern University Hospital, Bern, Switzerland (K.C.K., L.R., T.Z., P.W., S.S., A.M., A.A.K., T.P., S.B., C.M., B.M., S.W.); and Institute of Primary Health Care (P.J.), Institute of Social and Preventive Medicine (D.H.), and Clinical Trials Unit, Department of Clinical Research (S.W.), University of Bern, Bern, Switzerland.
authors.forename: Christina
authors.initials: C
authors.lastname: Moro
authors.affiliation: From the Department of Cardiology, Bern University Hospital, Bern, Switzerland (K.C.K., L.R., T.Z., P.W., S.S., A.M., A.A.K., T.P., S.B., C.M., B.M., S.W.); and Institute of Primary Health Care (P.J.), Institute of Social and Preventive Medicine (D.H.), and Clinical Trials Unit, Department of Clinical Research (S.W.), University of Bern, Bern, Switzerland.
authors.forename: Peter
authors.initials: P
authors.lastname: Jüni
authors.affiliation: From the Department of Cardiology, Bern University Hospital, Bern, Switzerland (K.C.K., L.R., T.Z., P.W., S.S., A.M., A.A.K., T.P., S.B., C.M., B.M., S.W.); and Institute of Primary Health Care (P.J.), Institute of Social and Preventive Medicine (D.H.), and Clinical Trials Unit, Department of Clinical Research (S.W.), University of Bern, Bern, Switzerland.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Meier
authors.affiliation: From the Department of Cardiology, Bern University Hospital, Bern, Switzerland (K.C.K., L.R., T.Z., P.W., S.S., A.M., A.A.K., T.P., S.B., C.M., B.M., S.W.); and Institute of Primary Health Care (P.J.), Institute of Social and Preventive Medicine (D.H.), and Clinical Trials Unit, Department of Clinical Research (S.W.), University of Bern, Bern, Switzerland.
authors.forename: Dik
authors.initials: D
authors.lastname: Heg
authors.affiliation: From the Department of Cardiology, Bern University Hospital, Bern, Switzerland (K.C.K., L.R., T.Z., P.W., S.S., A.M., A.A.K., T.P., S.B., C.M., B.M., S.W.); and Institute of Primary Health Care (P.J.), Institute of Social and Preventive Medicine (D.H.), and Clinical Trials Unit, Department of Clinical Research (S.W.), University of Bern, Bern, Switzerland. stephan.windecker@insel.ch.
authors.forename: Stephan
authors.initials: S
authors.lastname: Windecker
mesh_terms: D000328:Adult; D000368:Aged; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors
chemical_list: D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors
keywords: antiplatelet drug; gastrointestinal hemorrhage; percutaneous coronary intervention