Gastrointestinal Bleeding Common Following Angioplasty for MI

Patients with acute myocardial infarction (AMI) who undergo primary percutaneous coronary intervention (PCI) and antiplatelet therapy suffer a high incidence of upper gastrointestinal (GI) bleeding, according to a new study.

Researchers at Kaohsiung Chang Gung Memorial Hospital (Taiwan) conducted a prospective study involving 1,368 consecutive patients between May 2002 and September 2010 who experienced ST-segment elevation myocardial infarction (STEMI) and underwent subsequent primary PCI. The researchers wished to investigate the incidence of composite major adverse upper gastrointestinal (UGI) events (MAUGIEs) in patients with acute STEMI who underwent primary PCI and routinely received dual-antiplatelet therapy. For the study, MAUGIEs were defined as gastric ulcer, duodenal ulcer, gastroduodenal ulcer, or UGI bleeding.

The results showed that about one quarter of patients who developed MAUGIEs in the hospital died before discharge, compared to only 10.4% of patients who had no major upper GI events. The investigators also reported that 16% of the patients who suffered MAGUIEs in the hospital developed recurrent major upper GI events during an average follow-up of about 3.3 years; the vast majority of these patients (97%) received long-term clopidogrel. Age, advanced Killip score, and respiratory failure were all significantly and independently predictive of in-hospital composite MAUGIEs. The study was published early online on September 19, 2011, in the American Journal of Cardiology.

“Prophylaxis against upper GI bleeding with a proton pump inhibitor is indicated for patients hospitalized for AMI, particularly those of advanced Killip classes,” said lead author Hon-Kan Yip, MD. “Since a PPI is known to interact with the antiplatelet agent clopidogrel resulting in an elevated risk of intra-coronary thrombosis, an interval of at least four hours is suggested between the administrations of these agents”

The Killip classification stratifies AMI patients; individuals with a low Killip class are less likely to die within the first 30 days after MI than individuals with a high Killip class. Killip class I includes individuals with no clinical signs of heart failure; class II includes individuals with rales or crackles in the lungs, and elevated jugular venous pressure; class III describes individuals with frank acute pulmonary edema; and class IV describes individuals in cardiogenic shock or hypotension, and evidence of peripheral vasoconstriction (oliguria, cyanosis, or sweating).

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Kaohsiung Chang Gung Memorial Hospital