The Incidence of Non-Variceal Upper Gastrointestinal Hemorrhage After Percutaneous Coronary Intervention Among Patients Without Acute Myocardial Infarction Is Low: A National Analysis over 11 Months

Abstract

Introduction: Dual anti—platelet therapy is standard of care after percutaneous coronary intervention (PCI). Non—variceal upper gastrointestinal hemorrhage (NVUGIH) is a potential complication in patients on dual anti—platelet therapy. Despite this known risk, there continues to be paucity of literature on the exact incidence and impact of NVUGIH after PCI. We sought to determine the incidence of NVUGIH after PCI for patients without acute myocardial infarction 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. Inclusion criteria were in—hospital PCI and admissions during January. Exclusion criteria were principal diagnosis of non—ST or ST—elevation myocardial infarction and age less than 18 years. Primary outcome was incidence of NVUGIH during index admission and on 11 month follow—up. Secondary outcomes were: in—hospital and 11—month mortality, morbidity (hemorrhagic shock) and healthcare resource utilization (length of stay (LOS), mean total hospitalization costs and charges). Confounders were adjusted for using multivariate regression analysis. Results: 15,421 patients were included in the analysis. Only 0.3% and 2.7% of patients developed NVUGIH during index admission and 11 months follow, respectively. However, patients who developed NVUGIH during the index admission had higher in—hospital mortality, longer mean LOS, and higher mean total hospitalization costs and charges compared with those who did not (Table 1). Similarly, patients who experienced NVUGIH during the 11—month follow—up period had a higher 1—month mortality compared with those who did not. The NVUGIH associated additional resource utilization were also significant (Table 1). Conclusion: The incidence of non—variceal upper gastrointestinal hemorrhage after a percutaneous coronary intervention among patients without acute myocardial infarction is low both during the index admission and over an 11—month follow—up period. However, patients who develop NVUGIH after PCI have higher mortality, morbidity and healthcare resource utilization compared with those who do not.1187 Figure 1 No Caption available.