Incidence And Risk Factors Of Upper Gastrointestinal Bleeding In Patients With Acute Myocardial Infarction During Peri-PCI Period

Background Percutaneous coronary intervention(PCI)and combined use of potent antithrombotic drugs during perioperative period significantly reduce the acute myocardial infarction(AMI)recurrence in patients with ischemic events and mortality,however the above treatment measures in different extent increases the risk of perioperative bleeding,especially the upper gastrointestinal hemorrhage(upper gastrointestinal bleeding,UGIB),that is a major risk factor for serious adverse events and even death,in recent years,has aroused highly attention.Objective This study was to explore the PCI perioperative morbidity and risk factors of UGIB,to identify high-risk patients early for clinicians and to take active preventive measures to offer help.Methods In this retrospective analysis,We collected a total of 3655 patients with AMI who were admitted to the Department of Cardiology of Zunyi Medical College during January 2010 to December 2016,there were 85 cases of PCI in perioperative period who has had a UGIB,calculate the total incidence and annual incidence.There were 5 cases were excluded from the study,the remaining 80 AMI patients met the inclusion criteria,analysis of risk factors for these patients.The risk factors will be divided into two parts according to the different time points of PCI perioperative occured UGIB events in patients with AMI:1)a total of 49 cases of UGIB occurred after PCI,the control group was randomly selected by 1:3 ratio(a total of 147 cases),cases in the control group used to match the case data analysis,the selection criteria of the control group were AMI patients without UGIB events after PCI,etrospective analysis of clinical features,drug use,inspection results and PCI related index;(2)there were 31 cases of UGIB before PCI,similarly,the control group was randomly selected by 1:3 ratio(a total of 93 cases),the selection criteria of the control group were AMI patients without UGIB events during the perioperative of PCI,since we can not rule out the possibility that PCI may increase the risk of UGIB,in this group,the patients of UGIB occured before PCI was not affected by the factors related to PCI,this group will exclude analysis indexes related to PCI,the remaining indicators same as before.Results1.Morbidity and mortality: the total incidence of patients with AMI who occured UGIB during PCI perioperative period was 2.3%,UGIB occurred in preoperative PCI accounted for 0.8%,UGIB occurred after PCI accounted for 1.5%;the mortality rate of AMI patients with UGIB during PCI perioperative period was 7.5%,the mortality rate of UGIB occurred in preoperative PCI was 9.7%,UGIB occured after PCI was 6.1%,the former has a higher mortality rate.2.Risk factors of UGIB after PCI in patients with AMI:(1)in the index of age,length of stay,hospital mortality,duration of operation,the case group is higher than the control group,the difference was statistically significant(P < 0.05);in the index of previous history of peptic ulcer or bleeding,long term oral NSAID drug history,combined hypotension,class Killip II-IV,albumin<30g/L,renal dysfunction(creatinine clearance rate<60ml/min),three vessel lesion of coronary artery,RCA lesion,intraoperative heparin+GPI,use of ACEI/ARB,diuretics,the case group was significantly higher than the control group,the difference was statistically significant(P<0.05);in the use of prophylactic PPI,the control group was significantly higher than the case group,the difference was statistically significant(P<0.05);(2)Female,history of hypertension and diabetes,stroke,hyperlipidemia history,anemia,smoking history,drinking history,long-term oral anticoagulant,long-term hormone therapy,concurrent infection,received cardiopulmonary resuscitation,experience of malignant cardiovascular events,STEMI type,white blood cell count,blood lipid(TG,TC,HDL-C,LDL-C),LM,LAD,LCX lesions,Genisini score,emergency surgery,re-correction,temporary pacemaker,received thrombolytic therapy before surgery,preoperative use of low molecular weight heparin,tirofiban,tirofiban,low molecular weight heparin calcium after the operation,the use of aspirin,clopidogrel,statins drugs,beta blockers,CCB drugs,no significant differences in these factors between the two groups(P>0.05).(3)multivariate Logistic regression analysis showed: age,previous history of peptic ulcer or bleeding,renal insufficiency(creatinine clearance rate of 60ml/min),three vessel disease was an independent risk factor for UGIB after PCI in patients with AMI,and the use of prophylactic PPI was a protective factor.3.risk factors of preoperative UGIB in AMI patients with PCI:(1)the age of the case group was significantly higher than that of the control group(P<0.05),proportion of patients with anemia,previous peptic ulcer or hemorrhage,infection,hypotension,Killip II-IV,in-hospital mortality,albumin<30g/L,renal insufficiency(creatinine clearance< 60ml/min),the use of ACEI/ARB,beta blockers,diuretics,undergoing thrombolysis prior to bleeding,the case group was significantly higher than the control group,the difference was statistically significant(P<0.05);(2)female,history of hypertension and diabetes,stroke,hyperlipidemia history,smoking,drinking history,long-term oral NSAID drugs,long-term oral anticoagulant,long-term hormone therapy,duration of hospitalization,received cardiopulmonary resuscitation,STEMI type,white blood cell count,blood lipid(TG,TC,HDL-C,LDL-C),the use of aspirin,clopidogrel,statins,CCB drugs,before the bleeding of low molecular heparin and use of tirofiban,the proportion of preventive PPI,there was no significant difference between the two groups(P>0.05);(3)Multivariate Logistic regression analysis showed: Age,past peptic ulcer or bleeding history were independent risk factors for UGIB in AMI patients before PCI,while prophylactic use of PPI was not a protective factor for preoperative UGIB.Conclusion1.The overall incidence of UGIB events during perioperative PCI was 2.3%,the incidence of the disease in general showed a downward trend;the mortality during hospitalization was 7.5%,and the mortality rate was higher than that in the non-bleeding group;UGIB events after PCI will significantly prolong hospital stay and increase hospital costs.2.The risk factors for PCI in AMI patients during perioperative UGIB are mostly related to the patients themselves,age,previous history of peptic ulcer or bleeding,renal dysfunction(creatinine clearance rate < 60ml/min),and three vessel lesion of coronary artery are independent risk factors for UGIB in AMI patients after PCI,prophylactic use of PPI is a protective factor;age,past peptic ulcer or bleeding history are independent risk factors for UGIB in AMI patients before PCI,the use of prophylactic PPI did not provide a good protective effect in this group of patients,this suggests that patients with high UGIB risk should be given PPI as early and as adequately as possible to minimize the incidence of UGIB.