title: Temporal Trends, Predictors, and Outcomes of In-Hospital Gastrointestinal Bleeding Associated With Percutaneous Coronary Intervention.
abstract: Since the introduction of new antiplatelet and anticoagulant agents in the last decade, large-scale data studying gastrointestinal bleeding (GIB) in patients undergoing percutaneous coronary intervention (PCI) are lacking. Using the Nationwide Inpatient Sample, we identified all hospitalizations from 2006 to 2012 that required PCI. Temporal trends in the incidence and multivariate predictors of GIB associated with PCI were analyzed. A total of 4,376,950 patients underwent PCI in the United States during the study period. The incidence of GIB was 1.1%. Mortality rate in the GIB group was significantly higher (9.71% vs 1.1%, p <0.0001). Although the incidence of GIB remained stable during the study period (0.97% in 2006 to 1.19% in 2012), in-hospital mortality rate increased significantly from 7.9% in 2006 to 10.78% in 2012, with a peak of 12% in 2010. The GIB group had a longer median length of stay (5.80 vs 1.57 days) and an increased median cost of hospitalization ($26,564 vs $16,879). The predictors of GIB included cardiovascular co-morbidities such as acute myocardial infarction, cardiogenic shock, atrial fibrillation, congestive heart failure, valvular heart diseases, and a history of transient ischemic attack/stroke. Gastrointestinal co-morbidities including diverticulosis, esophageal cancer, stomach cancer, small intestine cancer, large intestine cancer, rectosigmoid cancer, gastrointestinal ulcer, and liver disease were predictors of GIB. Interestingly, a lower risk of GIB was associated with obese patients and patients with private insurance. A higher risk of GIB was noted in urgent versus elective admissions and weekend versus weekday admissions. In conclusion, the incidence of GIB in patients who underwent PCI remained stable from 2006 to 2012; however, the in-hospital mortality increased significantly. Identifying patients at higher risk for GIB is critically important to develop preventive strategies to reduce morbidity and mortality.
authors.affiliation: Division of Cardiology, University of Miami Miller School of Medicine, Miami, Florida. Electronic address: dr.nilesh.j.patel@gmail.com.
authors.forename: Nileshkumar J
authors.initials: NJ
authors.lastname: Patel
authors.affiliation: Division of Cardiology, Staten Island University Hospital, Staten Island, New York.
authors.forename: Dhaval
authors.initials: D
authors.lastname: Pau
authors.affiliation: Division of Cardiology, Staten Island University Hospital, Staten Island, New York.
authors.forename: Nikhil
authors.initials: N
authors.lastname: Nalluri
authors.affiliation: School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana.
authors.forename: Parth
authors.initials: P
authors.lastname: Bhatt
authors.affiliation: Division of Cardiology, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Badal
authors.initials: B
authors.lastname: Thakkar
authors.affiliation: Department of Medicine, Banner Baywood Medical Center, Mesa, Arizona.
authors.forename: Ritesh
authors.initials: R
authors.lastname: Kanotra
authors.affiliation: Department of Medicine, Saint Peter's University Hospital, New Brunswick, New Jersey.
authors.forename: Kanishk
authors.initials: K
authors.lastname: Agnihotri
authors.affiliation: Department of Medicine, Saint Peter's University Hospital, New Brunswick, New Jersey.
authors.forename: Nitesh
authors.initials: N
authors.lastname: Ainani
authors.affiliation: Department of Medicine, Saint Peter's University Hospital, New Brunswick, New Jersey.
authors.forename: Nilay
authors.initials: N
authors.lastname: Patel
authors.affiliation: Division of Cardiology, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Nish
authors.initials: N
authors.lastname: Patel
authors.affiliation: Faculty of Medicine, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada.
authors.forename: Sapna
authors.initials: S
authors.lastname: Shah
authors.affiliation: Department of Medicine, Lincoln Medical and Mental Health Center, Bronx, New York.
authors.forename: Sabeeda
authors.initials: S
authors.lastname: Kadavath
authors.affiliation: Department of Medicine, Mount Sinai St. Luke's Roosevelt Hospital, New York, New York.
authors.forename: Shilpkumar
authors.initials: S
authors.lastname: Arora
authors.affiliation: Division of Cardiology, Staten Island University Hospital, Staten Island, New York.
authors.forename: Azfar
authors.initials: A
authors.lastname: Sheikh
authors.affiliation: Division of Cardiology, The Everett Clinic, Everett, Washington.
authors.forename: Apurva O
authors.initials: AO
authors.lastname: Badheka
authors.affiliation: Division of Cardiology, Staten Island University Hospital, Staten Island, New York.
authors.forename: James
authors.initials: J
authors.lastname: Lafferty
authors.affiliation: Division of Cardiology, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Carlos
authors.initials: C
authors.lastname: Alfonso
authors.affiliation: Division of Cardiology, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Mauricio
authors.initials: M
authors.lastname: Cohen
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects*; D001281:Atrial Fibrillation / Q000453:epidemiology; D015897:Comorbidity; D016208:Databases, Factual; D017558:Elective Surgical Procedures; D004630:Emergencies; D005260:Female; D005767:Gastrointestinal Diseases / Q000453:epidemiology; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced* / Q000191:economics / Q000453:epidemiology / Q000401:mortality; D006333:Heart Failure / Q000453:epidemiology; D006349:Heart Valve Diseases / Q000453:epidemiology; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D002546:Ischemic Attack, Transient / Q000453:epidemiology; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000453:epidemiology; D062645:Percutaneous Coronary Intervention; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects*; D019106:Postoperative Hemorrhage / Q000139:chemically induced* / Q000191:economics / Q000453:epidemiology / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D012770:Shock, Cardiogenic / Q000453:epidemiology; D020521:Stroke / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors