title: Assessment of safety of performing percutaneous coronary intervention after a recent episode of gastrointestinal bleeding.
abstract: BACKGROUND
  Little literature exists on the risk of performing coronary intervention (PCI) on patients who have had recent gastrointestinal bleeding (GIB), although bleeding after PCI has been identified as a risk factor for long-term mortality.
  
  
  METHODS
  Patients within the Cleveland Clinic PCI database who had acute GIB within 30 days preceding PCI during the same hospitalization (n = 79) were retrospectively compared to those who had PCI without recent GIB (n = 10 979) for mortality and need for revascularization. Baseline characteristics, laboratory values, procedures, morbidities, and mortality were compared using chi-square test for categorical variables and using Wilcoxon rank sum test for continuous variables. Mortality data was obtained using Social Security Death Index and demonstrated using Kaplan-Meier method.
  
  
  RESULTS
  The GIB group had more prevalent history of peptic ulcer disease, GIB, gastrointestinal or liver disease (P < 0.0001), transient ischemic accident (P = 0.017), peripheral vascular disease (P = 0.0002), significant carotid artery occlusion (P = 0.023), and myocardial infarction (P < 0.0001). 47% of patients had upper GIB with 20% needing endoscopic intervention. This group had more anemia (P < 0.0001), heart failure (P = 0.0001), cardiogenic shock (10% versus 1.4%, P < 0.001), cardiac arrest (7.6% versus 1%, P < 0.001). GIB group had worse in-hospital mortality (P < 0.0001), long-term mortality (P < 0.001), and a 7.6% re-bleeding incidence.
  
  
  CONCLUSIONS
  Overall, the patients who had GIB preceding PCI had higher in-hospital mortality and long-term mortality compared with those without GIB before PCI.
authors: a Department of Internal Medicine , Cleveland Clinic , Cleveland , OH , USA.|b Department of Cardiology , University of Toledo Medical Center , Toledo , OH , USA.
authors: Saima
authors: S
authors: Karim
authors: a Department of Internal Medicine , Cleveland Clinic , Cleveland , OH , USA.
authors: Sweetheart T
authors: ST
authors: Ador-Dionisio
authors: c Department of Internal Medicine , University of Michigan , Ann Arbor , MI , USA.
authors: Munira
authors: M
authors: Karim
authors: a Department of Internal Medicine , Cleveland Clinic , Cleveland , OH , USA.
authors: Mohammad
authors: M
authors: Karim
authors: a Department of Internal Medicine , Cleveland Clinic , Cleveland , OH , USA.
authors: Sadaf S
authors: SS
authors: Khan
authors: a Department of Internal Medicine , Cleveland Clinic , Cleveland , OH , USA.
authors: Ashish
authors: A
authors: Atreja
authors: d Cleveland Clinic Lerner College of Medicine of Case Western Reserve University , Cleveland , OH , USA.|e Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic , Cleveland , OH , USA.
authors: Stephen
authors: S
authors: Ellis
mesh_terms: D000368:Aged; D003327:Coronary Disease / Q000150:complications / Q000188:drug therapy / Q000401:mortality / Q000601:surgery; D005260:Female; D005767:Gastrointestinal Diseases / Q000150:complications* / Q000453:epidemiology; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D000069451:Long Term Adverse Effects / Q000209:etiology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
chemical_list: D010975:Platelet Aggregation Inhibitors
keywords: Angina; Gastrointestinal bleeding; angiography; mortality; re-bleeding; revascularization