Document Detail

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.
MedLine Citation:
PMID:  19778672     Owner:  NLM     Status:  MEDLINE    
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.
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:
Type:  Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
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:
Created Date:  2009-09-25     Completed Date:  2009-11-10     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1293-302     Citation Subset:  AIM; IM    
Columbia University Medical Center and the Cardiovascular Research Foundation, New York, New York 10022, USA.
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MeSH Terms
Acute Coronary Syndrome / epidemiology,  therapy*
Age Factors
Angioplasty, Transluminal, Percutaneous Coronary
Anticoagulants / administration & dosage,  adverse effects
Coronary Artery Bypass
Gastrointestinal Hemorrhage / chemically induced*,  epidemiology*
Heparin / administration & dosage,  adverse effects
Hirudins / administration & dosage,  adverse effects
Ischemia / epidemiology
Length of Stay / statistics & numerical data
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
Thrombosis / epidemiology
Ticlopidine / administration & dosage,  adverse effects,  analogs & derivatives
Reg. No./Substance:
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

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