Gastrointestinal bleeding tied to poorer outcomes in STEMI patients
While gastrointestinal bleeding (GIB) is uncommon among patients with ST-elevation myocardial infarction (STEMI), the complication leads to greater morbidity, mortality and resource utilization, reports a new study.
The study included 1,450,696 STEMI patients, of which only 2.2 percent (n=32,624) were complicated with GIB. The incidence rate of GIB in STEMI decreased over time, going from 2.7 percent in the year 2003 to 2.0 percent in 2016 (p-trend<0.001). Those with GIB were older (73±14 vs 68±15 years; p<0.001) and were more likely to be female (44.9 percent vs 36.8 percent; p<0.001).
Compared with patients who did not develop the complication, those with GIB had significantly higher incidence rates of in-hospital mortality (28.2 percent vs 11.1 percent; p<0.001), acute kidney injury (29.8 percent vs 11.0 percent; p<0.001) and stroke (3.5 percent vs 1.5 percent; p<0.001).
In addition, patients with GIB were also more likely to need blood transfusion (29.3 percent vs 5.8 percent; p<0.001) and new dialysis requirements (2.5 percent vs 0.7 percent; p<0.001), and were less likely to be discharged from the hospital (nondischarge: 41.5 percent vs 25.8 percent; p<0.001).
Median length of stay (6 vs 3 days; p<0.001) as well as mean cost (USD 30,752±42,802 vs 21,372±23,552; p<0.001) were similarly significantly higher in patients who developed GIB.
“To our knowledge, this is the largest nationwide analysis examining the incidence and outcomes of GIB in patients admitted with STEMI,” said researchers. “[W]e believe that this study offers important insights into a high-risk cohort of patients in whom data to guide optimal therapy are scarce.”