Percutaneous Coronary Intervention in Patients With a History of Gastrointestinal Bleeding (From the Blue Cross Blue Shield of Michigan Cardiovascular Consortium)

• Published in: The American journal of cardiology 2021-09, Vol.155, p.9-15
• Main Authors: Meloche, Chelsea, Seth, Milan, Madder, Ryan D., Kurlander, Jacob E., Yaser, Jessica, Chattahi, Joseph, Collins, John, Lingam, Natesh, Arora, Dilip, Gurm, Hitinder S., Sukul, Devraj
• Format: Article
• Language: English
• Subjects: Angioplasty; Beneficiaries; Bleeding; Collaboration; Complications; Consortia; Government programs; Heart attacks; Hemoglobin; Ischemia; Matching; Medical prognosis; Medicare; Mortality; Patients; Standard deviation; Stroke; Survival; Transfusion
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2021.06.013

Potent antithrombotic agents are routinely prescribed after percutaneous coronary intervention (PCI) to reduce ischemic complications. However, in patients who are at an increased bleeding risk, this may pose significant risks. We sought to evaluate the association between a history of gastrointestinal bleeding (GIB) and outcomes after PCI. We linked clinical registry data from PCIs performed at 48 Michigan hospitals between 1/2013 and 3/2018 to Medicare claims. We used 1:5 propensity score matching to adjust for patient characteristics. In-hospital outcomes included bleeding, transfusion, stroke or death. Post-discharge outcomes included 90-day all-cause readmission and long-term mortality. Of 30,206 patients, 1.1% had a history of GIB. Patients with a history of GIB were more likely to be older, female, and have more cardiovascular comorbidities. After matching, those with a history of GIB (n = 312) had increased post-procedural transfusions (15.7% vs 8.4%; p < 0.001), bleeding (11.9% vs 5.2%; p < 0.001), and major bleeding (2.8% vs 0.6%; p = 0.004). Ninety-day readmission rates were similar among those with and without a history of GIB (34.3% vs 31.3%; p = 0.318). There was no significant difference in post-discharge survival (1 year: 78% vs 80%; p = 0.217; 5 years: 54% vs 51%; p = 0.189). In conclusion, after adjusting for baseline characteristics, patients with a history of GIB had increased risk of post-PCI in-hospital bleeding complications. However, a history of GIB was not significantly associated with 90-day readmission or long-term survival.