Division of Gastroenterology & Hepatology, The University of Texas Medical Branch, Galveston, Texas; Division of Gastroenterology & Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
Department of Internal Medicine, The University of Texas Medical Branch, Galveston, Texas, USA.
Gastrointest Endosc. 2020 Jul;92(1):65-74.e2. doi: 10.1016/j.gie.2020.01.039. Epub 2020 Feb 1.
Nonvariceal upper GI hemorrhage (NVUGIH) is a feared adverse event after percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI). We aimed to determine the incidence of NVUGIH after PCI for AMI and its impact on mortality, morbidity, and health care resource utilization over 11 months.
We used the Nationwide Readmission Database 2014. Inclusion criteria were (1) a principal diagnosis of ST or non-ST-elevation myocardial infarction, (2) in-hospital PCI, and (3) admission in January. Exclusion criteria were age less than 18 years and elective admission. The primary outcome was the 11-month incidence of NVUGIH. Secondary outcomes were 11-month mortality rate, prolonged mechanical ventilation, shock, upper endoscopy, length of stay, and total hospitalization costs and charges. Independent risk factors for NVUGIH were identified using multivariate logistic regression analysis.
A total of 22,669 patients were included in the study. The mean age was 63.8 years (range, 63.4-64.1 years), and 31.7% of patients were female. The 11-month incidence of NVUGIH was 1.6%. The onset of NVUGIH was associated with an increase in the 11-month mortality rate (adjusted odds ratio, 1.94; 95% confidence interval, 1.01-3.72; P =.04). The upper endoscopy, shock, and prolonged mechanical ventilation rates were 72%, 6.2%, and 1.9%, respectively. In total, 26,532 days were associated with NVUGIH, with a total health care in-hospital economic burden of U.S.$17.6 million. Independent predictors of NVUGIH were female gender, Charlson comorbidity score, and length of stay.
The 11-month incidence of NVUGIH among patients who undergo PCI for AMI is 1.6%. NVUGIH has a substantial impact on mortality, morbidity, and in-hospital health care resource utilization.
非静脉曲张性上消化道出血（NVUGIH）是急性心肌梗死（AMI）经皮冠状动脉介入治疗（PCI）后一种可怕的不良事件。我们旨在确定 AMI 患者 PCI 后 NVUGIH 的发生率及其对 11 个月死亡率、发病率和医疗资源利用的影响。
我们使用了 2014 年全国再入院数据库。纳入标准为：（1）ST 或非 ST 段抬高型心肌梗死的主要诊断；（2）院内 PCI；（3）入院时间为 1 月。排除标准为年龄小于 18 岁和择期入院。主要结局为 11 个月 NVUGIH 的发生率。次要结局为 11 个月死亡率、长时间机械通气、休克、上消化道内镜检查、住院时间和总住院费用和费用。使用多变量逻辑回归分析确定 NVUGIH 的独立危险因素。
共纳入 22669 例患者。平均年龄为 63.8 岁（范围为 63.4-64.1 岁），31.7%的患者为女性。11 个月 NVUGIH 的发生率为 1.6%。NVUGIH 的发生与 11 个月死亡率的增加有关（调整后的优势比，1.94；95%置信区间，1.01-3.72；P=.04）。上消化道内镜检查、休克和长时间机械通气的发生率分别为 72%、6.2%和 1.9%。共有 26532 天与 NVUGIH 相关，总院内医疗经济负担为 1760 万美元。NVUGIH 的独立预测因素为女性、Charlson 合并症评分和住院时间。
AMI 患者 PCI 后 11 个月 NVUGIH 的发生率为 1.6%。NVUGIH 对死亡率、发病率和院内医疗资源利用有重大影响。
