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Incidence of Non-variceal Upper Gastrointestinal Bleeding Worsens Outcomes with Acute Coronary Syndrome: Result of a National Cohort

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Abstract

Introduction

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.

Methods

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.

Results

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).

Discussion

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.

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Funding

No Grant support was utilized in this study. No financial arrangements related to research or assistance with manuscript preparation to disclose.

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Authors and Affiliations

  1. Department of Internal Medicine, Rutgers Robert Wood Johnson Medical School, 1 RWJ Place, New Brunswick, NJ, 09801, USA

    Lauren Pioppo, Debashis Reja & Augustine Tawadros

  2. Department of Gastroenterology, Rutgers Robert Wood Johnson Medical School, 1 RWJ Place, New Brunswick, NJ, 09801, USA

    Abhishek Bhurwal & Anish Patel

  3. Department of Internal Medicine, John H Stroger, Hospital of Cook County, 1969 Ogden Ave, Chicago, IL, 60612, USA

    Hemant Mutneja

  4. Department of Internal Medicine, University of Arkansas for Medical Sciences, 4301 W Markham St, Little Rock, AR, 72205, USA

    Akshay Goel

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  1. Lauren Pioppo
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Correspondence to Lauren Pioppo.

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Appendix

Appendix

See Table 7.

Table 7 ICD-10 codes utilized
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Pioppo, L., Bhurwal, A., Reja, D. et al. Incidence of Non-variceal Upper Gastrointestinal Bleeding Worsens Outcomes with Acute Coronary Syndrome: Result of a National Cohort. Dig Dis Sci 66, 999–1008 (2021). https://doi.org/10.1007/s10620-020-06266-7

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  • DOI: https://doi.org/10.1007/s10620-020-06266-7

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