| Gastrointestinal bleeding in patients with acute coronary syndromes: incidence, predictors, and clinical implications: analysis from the ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) trial. | |
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MedLine Citation:
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PMID: 19778672 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: We assessed the incidence, predictors, and outcomes of gastrointestinal bleeding (GIB) in patients with acute coronary syndromes (ACS). BACKGROUND: GIB is a potential hemorrhagic complication in patients with ACS treated with antithrombotic and/or antiplatelet medications. The clinical outcomes associated with GIB in this setting have not been systematically studied. METHODS: In the ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) trial, 13,819 patients with moderate- and high-risk ACS, enrolled at 450 centers in 17 countries between August 2003 and December 2005, were randomized to the open-label use of 1 of 3 antithrombin regimens (heparin plus a glycoprotein IIb/IIIa inhibitor, bivalirudin plus a glycoprotein IIb/IIIa inhibitor, or bivalirudin monotherapy). RESULTS: GIB within 30 days occurred in 178 patients (1.3%). Older age, baseline anemia, longer duration of study drug administration before angiogram, smoking, ST-segment deviation>or=1 mm, and diabetes were identified as independent predictors of GIB. On multivariable analysis, GIB was strongly associated with 30-day all-cause mortality (hazard ratio [HR]: 4.87 [interquartile range (IQR) 2.61 to 9.08], p<0.0001), cardiac mortality (HR: 5.35 [IQR 2.71 to 10.59], p<0.0001), and composite ischemia (HR: 1.94 [IQR 1.14 to 3.30], p=0.014), as well as with 1-year all-cause mortality (HR: 3.97 [IQR 2.64 to 5.99], p<0.0001), cardiac mortality (HR: 3.77 [IQR 2.14 to 6.63], p<0.0001), myocardial infarction (HR: 1.74 [IQR 1.01 to 3.02], p=0.047), and composite ischemia (HR: 1.90 [IQR 1.37 to 2.64], p=0.0001). Patients who experienced GIB had significantly higher rates of stent thrombosis compared with patients without GIB (5.8% vs. 2.4%, p=0.009). CONCLUSIONS: GIB is a serious condition in the scenario of ACS and is independently associated with mortality and ischemic complications. |
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Authors:
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Eugenia Nikolsky; Gregg W Stone; Ajay J Kirtane; George D Dangas; Alexandra J Lansky; Brent McLaurin; A Michael Lincoff; Frederick Feit; Jeffrey W Moses; Martin Fahy; Steven V Manoukian; Harvey D White; E Magnus Ohman; Michel E Bertrand; David A Cox; Roxana Mehran |
Publication Detail:
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Type: Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Journal of the American College of Cardiology Volume: 54 ISSN: 1558-3597 ISO Abbreviation: J. Am. Coll. Cardiol. Publication Date: 2009 Sep |
Date Detail:
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Created Date: 2009-09-25 Completed Date: 2009-11-10 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8301365 Medline TA: J Am Coll Cardiol Country: United States |
Other Details:
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Languages: eng Pagination: 1293-302 Citation Subset: AIM; IM |
Affiliation:
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Columbia University Medical Center and the Cardiovascular Research Foundation, New York, New York 10022, USA. enikolsky@crf.org |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Acute Coronary Syndrome
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epidemiology,
therapy* Age Factors Aged Angioplasty, Transluminal, Percutaneous Coronary Anticoagulants / administration & dosage, adverse effects Coronary Artery Bypass Female Gastrointestinal Hemorrhage / chemically induced*, epidemiology* Heparin / administration & dosage, adverse effects Hirudins / administration & dosage, adverse effects Humans Incidence Ischemia / epidemiology Length of Stay / statistics & numerical data Male Middle Aged Multivariate Analysis Myocardial Infarction / epidemiology Peptide Fragments / administration & dosage, adverse effects Platelet Aggregation Inhibitors / administration & dosage, adverse effects Platelet Glycoprotein GPIIb-IIIa Complex / antagonists & inhibitors Recombinant Proteins / administration & dosage, adverse effects Risk Assessment Sex Factors Stents Thrombosis / epidemiology Ticlopidine / administration & dosage, adverse effects, analogs & derivatives |
| Chemical | |
Reg. No./Substance:
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0/Anticoagulants; 0/Hirudins; 0/Peptide Fragments; 0/Platelet Aggregation Inhibitors; 0/Platelet Glycoprotein GPIIb-IIIa Complex; 0/Recombinant Proteins; 128270-60-0/bivalirudin; 55142-85-3/Ticlopidine; 9005-49-6/Heparin; 90055-48-4/clopidogrel |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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