Elsevier

The American Journal of Cardiology

Volume 155, 15 September 2021, Pages 9-15
The American Journal of Cardiology

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

https://doi.org/10.1016/j.amjcard.2021.06.013Get rights and content

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.

Section snippets

Methods

We performed a retrospective analysis using data collected by the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2), a quality improvement consortium that maintains a registry of all patients undergoing PCI at 48 nonfederal hospitals in Michigan.14,15 Briefly, BMC2 collects data from all nonfederal hospitals in Michigan using the National Cardiovascular Data Registry CathPCI data collection form. The registry is further enhanced by the inclusion of novel variables and rigorous

Results

A total of 30,206 patients who underwent PCI at 48 non-federal hospitals in Michigan between January 2013 to March 2018 were linked between the BMC2 clinical registry and the MVC claims-based registry. Of the 30,206 patients who underwent PCI, 342 (1.1%) patients had a history of GIB (Figure 1). Baseline characteristics of the study population are presented in Table 1.

In the unmatched cohort, a history of GIB was significantly associated with increased rates of in-hospital death (5% vs 1.4%; p

Discussion

The main finding of this study is that a history of GIB prior to PCI was associated with a higher rate of post-PCI in-hospital bleeding complications including the need for transfusion. Although identified in only 1.1% of >30,000 patients undergoing PCI during this study, a history of GIB was associated with significantly higher risk of in-hospital post-PCI bleeding events. Patients with a history of GIB also had a high rate of 90-day readmission and mortality; however, after adjusting for

Disclosures

Dr. Sukul, Mr. Seth, and Ms. Yaser receive salary support from the Blue Cross Blue Shield of Michigan.  Dr. Gurm receives research support from Blue Cross and Blue Shield of Michigan, and Michigan Translational Research and Commercialization for Life Sciences Innovation Hub. He is the co-founder of, owns equity in, and is a consultant to Amplitude Vascular Systems. He also owns equity in Jiaxing Bossh Medical Technology Partnership and is a consultant for Osprey Medical. He is the chair of the

Acknowledgments

The authors are indebted to all the study coordinators, investigators and patients who participated in the BMC2 registry. All authors listed meet the authorship criteria according to the latest guidelines of the International Committee of Medical Journal Editors and all authors agree with the manuscript.

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  • Funding: This work was supported by the Blue Cross Blue Shield of Michigan and Blue Care Network as part of the Blue Cross Blue Shield of Michigan Value Partnerships program. The funding source supported data collection and the data coordinating center but had no role in the study concept, interpretation of findings, preparation, final approval, or decision to submit the manuscript.

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