Department of Internal Medicine, Rutgers Robert Wood Johnson Medical School, 1 RWJ Place, New Brunswick, NJ, 09801, USA.
Department of Gastroenterology, Rutgers Robert Wood Johnson Medical School, 1 RWJ Place, New Brunswick, NJ, 09801, USA.
Dig Dis Sci. 2021 Apr;66(4):999-1008. doi: 10.1007/s10620-020-06266-7. Epub 2020 Apr 23.
Upper gastrointestinal bleeding (UGIB) is a feared complication of acute coronary syndrome (ACS) and has been shown to increase morbidity and mortality. Our aim was to assess the incidence of non-variceal UGIB in patients with ACS in a national cohort and its impact on in-hospital mortality, length of stay (LOS), and cost of hospitalization.
This was a retrospective cohort study analyzing the 2016 Nationwide Inpatient Sample (NIS) utilizing ICD 10 CM codes. Principal discharge diagnoses of ACS (STEMI, NSTEMI, and UA) in patients over 18 years old were included. Non-variceal UGIB with interventions including endoscopy, angiography, and embolization were also evaluated. Primary outcome was the national incidence of concomitant non-variceal UGIB in the setting of ACS. Secondary outcomes included in-hospital mortality, length of stay, and cost of stay.
A total of 661,404 discharges with principal discharge diagnosis of ACS in 2016 were analyzed. Of the included cohort, 0.80% (n = 5324) were complicated with non-variceal UGIB with increased frequency in older patients (OR 1.03, 95% CI 1.03-1.04; p = 0.0001). Despite endoscopic evaluation, 17.35% (n = 744) underwent angiography. After adjustment of confounders, inpatient mortality was significantly higher in patients with UGIB (OR 2.07, 95% CI 1.63-2.63, p = 0.0001). Non-variceal UGIB also led to significantly longer LOS (10.38 days vs 4.37 days, p = 0.0001) and cost of stay ($177,324 vs $88,468, p = 0.0001).
Our study shows that the national incidence of non-variceal UGIB complicating ACS is low at less than 1%, but resulted in significantly higher inpatient mortality, LOS, and hospitalization charges.
上消化道出血（UGIB）是急性冠状动脉综合征（ACS）的一种可怕并发症，已被证明会增加发病率和死亡率。我们的目的是评估全国队列中 ACS 患者中非静脉曲张性 UGIB 的发生率及其对住院死亡率、住院时间（LOS）和住院费用的影响。
这是一项回顾性队列研究，分析了 2016 年全国住院患者样本（NIS），使用 ICD 10 CM 代码。纳入年龄在 18 岁以上的 ACS（STEMI、NSTEMI 和 UA）患者的主要出院诊断。还评估了包括内镜检查、血管造影和栓塞在内的非静脉曲张性 UGIB 干预措施。主要结果是 ACS 背景下同时发生非静脉曲张性 UGIB 的全国发生率。次要结果包括住院死亡率、住院时间和住院费用。
共分析了 2016 年主要出院诊断为 ACS 的 661,404 例出院患者。在所纳入的队列中，0.80%（n=5324）并发非静脉曲张性 UGIB，且老年患者的发生率增加（OR 1.03，95%CI 1.03-1.04；p=0.0001）。尽管进行了内镜评估，但仍有 17.35%（n=744）患者进行了血管造影。在调整混杂因素后，UGIB 患者的住院死亡率明显更高（OR 2.07，95%CI 1.63-2.63，p=0.0001）。非静脉曲张性 UGIB 还导致 LOS 显著延长（10.38 天 vs 4.37 天，p=0.0001）和住院费用增加（$177,324 与 $88,468，p=0.0001）。
我们的研究表明，ACS 并发非静脉曲张性 UGIB 的全国发生率不到 1%，但导致住院死亡率、LOS 和住院费用明显增加。
