Incidence,predictorsandoutcomeofuppergastrointestinalbleedinginpatientswithacutecoronarysyndromesAryehShaleva,⁎,DoronZahgera,VictorNovackb,OhadEtzionc,AviShimonya,HarelGilutza,CarlosCafria,ReubenIliaa,AlexanderFichcaDepartmentofCardiology,SorokaUniversityMedicalCenter,FacultyofHealthSciences,BenGurionUniversityoftheNegev,Be'erSheva,IsraelbSorokaClinicalResearchCenter,Be'erSheva,IsraelcInstituteofGastroenterology,SorokaUniversityMedicalCenter,FacultyofHealthSciences,BenGurionUniversityoftheNegev,Be'erSheva,IsraelabstractarticleinfoArticlehistory:Received4December2009Receivedinrevisedform4December2010Accepted22December2010Availableonline31January2011Keywords:UppergastrointestinalbleedingAcutecoronarysyndromesAntithrombotictherapyBackground:Thebroadutilizationofrevascularizationandantithrombotictherapyinpatientswithacutecoronarysyndrome(ACS)isassociatedwithasubstantialriskofbleedingprimarilyrelatedtoarterialpunctures,whichcanleadtoworseoutcome.Aim:Todefinethecharacteristicsandoutcomeofpatientswhodevelopuppergastrointestinalbleeding(UGIB)inthesettingofACS.Methods:Weidentifiedallpatientsadmittedtothecoronarycareunitbetween10/96and11/07withACSwhodevelopedUGIB.Foreachcase3controlcaseswerematched.Multiplebaselinecharacteristics,aswellasantithromboticagents,revascularizationstrategyandendoscopyreportswereassessed.Mortalityat30-daywastheprimaryendpointoftheanalysis.Results:Of7240ACSpatients,64(0.9%)developedUGIB.Therewerenosignificantdifferencesbetweengroupsintheprevalenceofdiabetesandotherriskfactors,revascularizationstrategy,ortheuseofprotonpumpinhibitors.PatientswithUGIBsufferedmorefromrenalimpairmentandleftventriculardysfunctionandweremorefrequentlytreatedwiththienopyridines(89%vs.68%,p=0.002)andglycoproteinIIb/IIIainhibitors(39%vs.24%,p=0.03).Thecombinationofunfractionatedheparin(UFH)withglycoproteinIIb/IIIainhibitorswasstronglyassociatedwithUGIB(OR:2.87,95%CI1.66–4.97).PatientswhodevelopedUGIBhadasubstantiallyhigher30-daymortalityrate(33%vs.5%,pb0.001).Conclusions:UGIBinpatientswithACSisassociatedwithamarkedlyincreasedmortality.Previouspepticdiseaseandtheuseofcombinedanti-platelettherapy,especiallyinconjunctionwithheparin,arestrongriskfactorsforthisseriouscomplication.©2010ElsevierIrelandLtd.Allrightsreserved.1.IntroductionTheuniversaluseofcombinationantithrombotictherapyandthecontinuousevolutionofmechanicalrevascularizationstrategiesledtoamarkedimprovementintheoutcomeofpatientswithacutecoronarysyndromes(ACS)[1–6]butinvolveasubstantialriskofbleeding[7,8].ThestrongassociationbetweenbleedingandadverseoutcomeinpatientswithACShasrecentlyreceivedsubstantialattentionandstrategiesaresoughttominimizetheriskofbleedingwhilemaintainingtheefficacyofantithrombotictherapy[9–12].ThevastmajorityofbleedingepisodesinpatientswithACSisrelatedtoarterialpuncturesites[13,14]andispredictiveofadverseproceduralandpatientoutcome[15].Thecharacteristicsandoutcomeofpatientswhodevelopuppergastrointestinalbleeding(UGIB)inthissettinghavereceivedlittleattention.TheAcuteCatheterizationandUrgentInterventionTriageStrategy(ACUITY)investigatorsrecentlydemonstratedtheadverseprognosticoutcomeassociatedwithUGIBinpatientswithACS[16].ThecharacteristicsandoutcomeofUGIBinanunselectedACSpopulationmaydiffersubstantiallyfromthoseobservedinaclinicaltrial.WesoughttostudytheseparametersinalargecohortofpatientswithACS.2....
