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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

Eugenia Nikolsky, MD, PhD^_*,_*, Gregg W. Stone, MD^_*, Ajay J. Kirtane, MD, SM^_*, George D. Dangas, MD, PhD^_*, Alexandra J. Lansky, MD^_*, Brent McLaurin, MD, A. Michael Lincoff, MD, Frederick Feit, MD, Jeffrey W. Moses, MD^_*, Martin Fahy, MSc^_*, Steven V. Manoukian, MD^||, Harvey D. White, MD^_**, E. Magnus Ohman, MD^¶, Michel E. Bertrand, MD, David A. Cox, MD^# and Roxana Mehran, MD^_*

^_* Columbia University Medical Center and the Cardiovascular Research Foundation, New York, New York
New York University, New York, New York
AnMed Health, Anderson, South Carolina
The Cleveland Clinic, Cleveland, Ohio
^|| Sarah Cannon Research Institute and Hospital Corporation of America, Inc., Nashville, Tennessee
^¶ Duke University, Durham, North Carolina
^# Lehigh Valley Hospital, Allentown, Pennsylvania
^_** Auckland City Hospital, Auckland, New Zealand
Hopital Cardiologique, Lille, France

View larger version (19K): [in this window] [in a new window] [Download PPT slide]   Figure 1 Ischemic Events at 30 Days and 1 Year in Patients With and Without GIB Patients with versus without gastrointestinal bleeding (GIB) have significantly increased 30-day (A) and 1-year (B) rates of cardiac and all-cause mortality, myocardial infarction, and composite ischemic outcome.

View larger version (18K): [in this window] [in a new window] [Download PPT slide]   Figure 2 Cumulative Risk of All-Cause and Cardiac Death in Patients With and Without GIB By Kaplan-Meier estimates, patients with versus without gastrointestinal bleeding (GIB) had significantly higher all-cause (A) and cardiac (B) death at 1 year.

View larger version (39K): [in this window] [in a new window] [Download PPT slide]   Figure 3 Multivariable Predictors of 1-Year Individual and Composite Ischemic End Point Gastrointestinal bleeding was an independent predictor of 1-year all-cause mortality, cardiac mortality, myocardial infarction, and the composite ischemic end point. CABG = coronary artery bypass grafting; CI = confidence interval; HR = hazard ratio; MI = myocardial infarction; PCI = percutaneous coronary intervention.