PMID- 21277643 OWN - NLM STAT- MEDLINE DCOM- 20130312 LR - 20120521 IS - 1874-1754 (Electronic) IS - 0167-5273 (Linking) VI - 157 IP - 3 DP - 2012 Jun 14 TI - Incidence, predictors and outcome of upper gastrointestinal bleeding in patients with acute coronary syndromes. PG - 386-90 LID - 10.1016/j.ijcard.2010.12.081 [doi] AB - BACKGROUND: The broad utilization of revascularization and antithrombotic therapy in patients with acute coronary syndrome (ACS) is associated with a substantial risk of bleeding primarily related to arterial punctures, which can lead to worse outcome. AIM: To define the characteristics and outcome of patients who develop upper gastrointestinal bleeding (UGIB) in the setting of ACS. METHODS: We identified all patients admitted to the coronary care unit between 10/96 and 11/07 with ACS who developed UGIB. For each case 3 control cases were matched. Multiple baseline characteristics, as well as antithrombotic agents, revascularization strategy and endoscopy reports were assessed. Mortality at 30-day was the primary endpoint of the analysis. RESULTS: Of 7240 ACS patients, 64 (0.9%) developed UGIB. There were no significant differences between groups in the prevalence of diabetes and other risk factors, revascularization strategy, or the use of proton pump inhibitors. Patients with UGIB suffered more from renal impairment and left ventricular dysfunction and were more frequently treated with thienopyridines (89% vs. 68%, p=0.002) and glycoprotein IIb/IIIa inhibitors (39% vs. 24%, p=0.03). The combination of unfractionated heparin (UFH) with glycoprotein IIb/IIIa inhibitors was strongly associated with UGIB (OR: 2.87, 95% CI 1.66-4.97). Patients who developed UGIB had a substantially higher 30-day mortality rate (33% vs. 5%, p<0.001). CONCLUSIONS: UGIB in patients with ACS is associated with a markedly increased mortality. Previous peptic disease and the use of combined anti-platelet therapy, especially in conjunction with heparin, are strong risk factors for this serious complication. CI - Copyright (c) 2010 Elsevier Ireland Ltd. All rights reserved. FAU - Shalev, Aryeh AU - Shalev A AD - Department of Cardiology, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Be'er Sheva, Israel. ary.shalev@gmail.com FAU - Zahger, Doron AU - Zahger D FAU - Novack, Victor AU - Novack V FAU - Etzion, Ohad AU - Etzion O FAU - Shimony, Avi AU - Shimony A FAU - Gilutz, Harel AU - Gilutz H FAU - Cafri, Carlos AU - Cafri C FAU - Ilia, Reuben AU - Ilia R FAU - Fich, Alexander AU - Fich A LA - eng PT - Journal Article DEP - 20110131 PL - Netherlands TA - Int J Cardiol JT - International journal of cardiology JID - 8200291 RN - 0 (Fibrinolytic Agents) RN - 0 (Platelet Aggregation Inhibitors) RN - 0 (Platelet Glycoprotein GPIIb-IIIa Complex) SB - IM MH - Acute Coronary Syndrome/complications/*diagnosis/*epidemiology MH - Aged MH - Case-Control Studies MH - Female MH - Fibrinolytic Agents/adverse effects MH - Gastrointestinal Hemorrhage/*diagnosis/*epidemiology/etiology MH - Hospital Mortality/trends MH - Humans MH - Incidence MH - Male MH - Middle Aged MH - Platelet Aggregation Inhibitors/adverse effects MH - Platelet Glycoprotein GPIIb-IIIa Complex/antagonists & inhibitors MH - Predictive Value of Tests MH - Retrospective Studies MH - Risk Factors MH - Treatment Outcome MH - Upper Gastrointestinal Tract/*pathology EDAT- 2011/02/01 06:00 MHDA- 2013/03/13 06:00 CRDT- 2011/02/01 06:00 PHST- 2009/12/04 00:00 [received] PHST- 2010/12/04 00:00 [revised] PHST- 2010/12/22 00:00 [accepted] PHST- 2011/02/01 06:00 [entrez] PHST- 2011/02/01 06:00 [pubmed] PHST- 2013/03/13 06:00 [medline] AID - S0167-5273(10)01141-1 [pii] AID - 10.1016/j.ijcard.2010.12.081 [doi] PST - ppublish SO - Int J Cardiol. 2012 Jun 14;157(3):386-90. doi: 10.1016/j.ijcard.2010.12.081. Epub 2011 Jan 31.