603 Incidence of Non-Variceal Upper Gastrointestinal Bleeding Worsens Outcomes With Acute Coronary Syndrome: Result of a National Cohort

Abstract

INTRODUCTION: Upper gastrointestinal bleeding (UGIB) is a feared complication of acute coronary syndromes (ACS) and has been shown to increase morbidity and mortality. UGIB may occur due to stress-related mucosal disease as well as from standard therapy with antiplatelet and anticoagulant medications. Our aim was to assess the incidence of non-variceal UGIB in patients with ACS in a national cohort and its impact on in-hospital mortality, length of stay (LOS), and cost of hospitalization. METHODS: This was a retrospective cohort study using the 2016 Nationwide Inpatient Sample (NIS) utilizing ICD 10 CM codes. Principal discharge diagnoses of ACS (STEMI, NSTEMI and UA) in patients over 18 years of age were included. Non-variceal UGIB with interventions including endoscopy, angiography and embolization were also evaluated using ICD 10 CM. Primary outcome was national incidence of concomitant non-variceal UGIB in the setting of ACS. Secondary outcomes included impact on in-hospital mortality, LOS and cost of stay. Proportions were compared using Fisher's exact test and continuous variables using Student t-test. Multivariable and Poisson regression were performed. RESULTS: A total of 661,324 discharges with principal discharge diagnosis of ACS in 2016 were included. Patient demographics are listed in Table 1. Of this cohort, 0.65% (n = 4289) were complicated with non-variceal UGIB with increased frequency in older patients (OR 1.04, 95% CI 1.04-1.05; P = 0.001). Despite endoscopic evaluation, 17.35% (n = 744) underwent angiography whereas embolization was required in 0.5% (n = 21) of these cases. After adjustment of confounders (see Table 2), inpatient mortality was significantly higher in patients with UGIB (OR 1.49, 95% CI 1.10-2.03; P = 0.01). Non-variceal UGIB also led to significantly longer LOS (10.21 days vs 4.38 days; P = 0.001) and total cost of stay ($177,000 vs $88,592, P < 0.0001) (Table 3 and Table 4). CONCLUSION: We performed a retrospective cohort study which showed that the national incidence of non-variceal UGIB complicating ACS is low (less than 1%). However, as expected, its occurrence in ACS patients resulted in significantly higher inpatient mortality, LOS, and hospitalization charges. Limitations of the study include lack of information on antiplatelet or anticoagulant therapy which could affect outcomes. Further studies are needed to determine the safety and efficacy of endoscopy in patients on dual antiplatelet agents or anticoagulation.