NEW YORK (Reuters Health) – Gastrointestinal bleeding in patients with acute coronary syndromes (ACS) is independently associated with high rates of mortality, myocardial infarction and stent thrombosis, researchers report in the Journal of the American College of Cardiology for September 29.

Their findings are drawn from 13,819 patients with moderate- to high-risk ACS who were participating in the Acute Catheterization and Urgent Intervention Triage Strategy (ACUITY) trial between 2003 and 2005.

Patients were randomly assigned to open label use of one of three antithrombotic regimens: heparin plus a glycoprotein IIb/IIIa inhibitor, or bivalirudin plus a glycoprotein IIb/IIIa inhibitor, or bivalirudin alone.

The authors, led by Dr. Eugenia Nikolsky at Columbia University Medical Center in New York, found that gastrointestinal bleeding occurred in 178 patients within 30 days of randomization (1.3%).

“The incidence of gastrointestinal bleeding is increased in the elderly, smokers and patients with baseline anemia,” Dr. Nikolsky noted in an email to Reuters Health.

On multivariate analysis, gastrointestinal bleeding was strongly associated with 30-day all-cause mortality (hazard ratio 4.87), cardiac mortality (HR 5.35), and composite ischemia (HR 1.94).

Gastrointestinal bleeding was also strongly associated with 1-year all-cause mortality (HR 3.97), cardiac mortality (HR 3.77), myocardial infarction (HR 1.74), and composite ischemia (HR 1.90).

In addition, patients with gastrointestinal bleeding had significantly higher rates of stent thrombosis (5.8% vs 2.4%).

“At the time of the writing of our paper,” Dr. Nikolsky told Reuters Health, “the results of the randomized FAMOUS trial (Famotidine for the Prevention of Peptic Ulcers in Users of Low-dose Aspirin trial) recently published in the Lancet were not yet available; this trial…showed that the histamine H2 receptor antagonist famotidine may be active in primary prevention of gastrointestinal bleeding in patients treated with antiplatelet therapy.” (See Reuters Health report, July 6, 2009.)

Reference:
J Am Coll Cardiol 2009;54:1293-1302.