Non-Variceal Upper Gastrointestinal Hemorrhage Is a Rare Complication After Percutaneous Coronary Intervention for Myocardial Infarction, but Has a Detrimental Effect on Mortality: A National Analysis Over 11 Months

Abstract

Introduction: Non-variceal upper gastrointestinal hemorrhage (NVUGIH) is a feared complication after a percutaneous coronary intervention (PCI) for ST-elevation Myocardial infarction (STEMI) and non-STEMI. We sought to determine the incidence of NVUGIH after PCI among patients with STEMI or NSTEMI over an 11-month follow-up period, and its impact on mortality, morbidity and healthcare resource utilization using the largest national readmission database in the United States. Methods: This is a retrospective cohort study using the 2014 National Readmission Database (NRD). Inclusion criteria were: i) a principal diagnosis of STEMI or NSTEMI ii) An in-hospital PCI iii) Admission in January. Exclusion criteria were age less than 18 years and elective admission. All readmissions to any hospital for a principal diagnosis of NVUGIH within 11 months of the index admission were recorded for each patient. The primary outcome was incidence of NVUGIH. Secondary outcomes were 11-months mortality rate, and NVUGIH associated morbidity [prolonged mechanical ventilation (PMV) and shock] and resource utilization [length of stay (LOS) and total hospitalization costs and charges]. Independent risk factors for NVUGIH were also identified using multivariate logistic regression analysis. Results: 22,669 patients were included in the study. The mean age was 63.8 (63.4-64.1) years and 31.7% of patients were female. The 11-month incidence of NVUGIB was 1.6%. The onset of NVGIH was associated with an increase in 11-months mortality rate from 1.9% to 7.8% (adjusted OR: 1.94 (1.01-3.72, p=0.04). The proportion of patients with NVUGIH who developed shock was 6.2% (3.3%-11.3%), while those who required PMV was 1.9% (0.6% - 5.8%). The mean LOS for NVUGIH related readmissions was 5.1 (4.3-5.9) days, with an associated mean total hospitalization costs and charges of $10,492 ($9,169-$-11,815) and $41,030 ($34,766- $47,295), respectively. The total hospital days associated with NVUGIH related readmissions was 2,211 days, with a total healthcare in-hospital economic burden of $17.6 million. Independent predictors of NVUGIH were: female gender, charlson co-morbidity score, and LOS (Table 1). Conclusion: NVUGIH is an uncommon complication among patients who undergo PCI for STEMI or NSTEMI, with an 11-month incidence of 1.6%. However, the development of NVUGIH has a substantial impact on mortality, morbidity and in-hospital healthcare resource utilization in this patient population.532 Figure 1 No Caption available.