Abstract 2026: Incidence, Predictors and Outcome of Upper Gastrointestinal Bleeding in Patients with Acute Coronary Syndromes

Abstract

Purpose: The broad utilization of revascularization and antithrombotic drugs has improved outcome of patients with acute coronary syndromes (ACS). Nevertheless, these strategies are associated with a substantial risk of bleeding, which is associated in turn with increased mortality. Most bleeding episodes are related to arterial punctures. The characteristics and outcome of patients who develop upper gastrointestinal bleeding (UGIB) in this setting have received little attention. Methods: Using computerized databases we identified all patients admitted to our center between 10/96 and 11/07 for an ACS who developed UGIB during their hospital stay. For each case 3 control cases matched for age, gender, and ACS subtype were randomly selected. Multiple baseline characteristics, as well as antithrombotic agents, revascularization strategy, endoscopy reports and 30-day mortality were recorded. Results: 7240 ACS patients were admitted to our ICCU during the study period, of whom 64 (0.9%) developed UGIB. There were no significant differences between groups in the prevalence of diabetes and other risk factors, revascularization strategy, or the use of proton pump inhibitors or H2-blockers. Patients who bled suffered more from renal impairment and LV dysfunction and were more frequently treated with thienopyridines (89% vs. 68%, p=0.002) and GPIIb/IIIa receptor blockers (39% vs. 24%, p=0.03), but were treated equally with aspirin (100% vs. 96%, p=0.2). The combination of unfractionated heparin (UFH) with either GP IIb/IIIa receptor blockers or enoxaparin was also associated with UGIB (30% vs. 7%, p=0.001 and 36% vs. 18%, p=0.005, respectively). Patients who developed UGIB had a substantially higher 30-day mortality rate (33% vs. 6%, p<0.001). Among patients for whom endoscopy was available (35 patients of 64) the source of bleeding was similarly distributed between the esophagus, stomach and duodenum. Gastritis and duodenitis were the most common findings. Conclusions: UGIB in patients with ACS is associated with very high mortality. Patients who bled tended to have a greater degree of cardiac and renal dysfunction. The use of combined anti-platelet therapy, especially in conjunction with UFH is a strong risk factor for this serious complication.