Validation of prediction tools for GI bleeding in patients on dual anti-platelet therapy after percutaneous coronary intervention

Abstract

Background & AimsThe management of dual anti-platelet therapy (DAPT) after percutaneous coronary intervention (PCI) and gastrointestinal bleeding (GIB) remains a clinical dilemma. We sought to identify predictors of a GIB and a rebleed and to determine whether a rebleed increases the risk of major adverse cardiovascular events (MACE). MethodsIn this single-center retrospective study, patients undergoing PCI were identified. The primary and secondary endpoints were a GIB at 180 days, and a rebleed or MACE at 365 days. Logistic regression was used to identify predictors of GIB and rebleed. Cox Proportional Hazard modeling was used to determine whether rebleed can predict MACE. ResultsA total of 536 patients were included. On multivariable analysis, PCI for acute coronary syndrome was associated with 95% increased odds of GIB, p < 0.001. The P2Y12 inhibitor was continued in > 90% of patients, which trended towards significance for a rebleed, p < 0.10. The HAS-BLED score, including a labile INR and prior major bleeding, were strongly associated with a rebleed, p ≤ 0.009. A rebleed was associated with a 115% increased risk of MACE, p = 0.02. We derived a novel risk score, named the SIGE score, to predict a rebleed at 365 days with a high predictive accuracy, AUC 0.773 (95% CI: 0.702 – 0.845). ConclusionThe SIGE score may help to predict rebleeding, which was shown to be associated with an increased risk of MACE. Further external validation is needed.