Percutaneous Coronary Intervention in Cancer Patients: Assessing 30-Day Readmissions for Gastrointestinal Bleeding.

Abstract

Background: Percutaneous coronary intervention (PCI) is a procedure used to treat coronary artery disease. Cancer patients frequently present with comorbidities, including cardiovascular disease, which may necessitate PCI. However, oncologic treatments can increase the risk of complications during and after PCI. One such complication is upper gastrointestinal (GI) bleeding, which can occur due to concomitant use of anticoagulant and antiplatelet medications during PCI, as well as underlying cancer-related factors such as tumor invasion, mucosal damage, or coagulopathy. This study examined the readmission rates for nonvariceal UGI bleeding post-PCI.

Methods: This retrospective cohort study analyzed cancer patients who underwent PCI and were readmitted within 30 days for GI bleed. Data were acquired from the Nationwide Readmission Database (NRD) from 2016 to 2020 and analyzed using multivariable logistic regression.

Results: A total of 2,705,049 patients were included in the analysis. Eight thousand eight hundred ninty (0.3%) patients were readmitted for GI bleeding within 30 days post-PCI (P<0.001). Over the study period, there was a slight uptick in the trend of readmissions for bleeding, rising from 0.3% to 0.4%. Those readmitted were more likely to be male (P<0.001), aged more than 61 years (P<0.001), and covered by Medicare insurance (P<0.001). Notably, patients readmitted for GI bleeding within 30 days post-PCI had a significantly higher incidence of cancer diagnosis (58% with cancer vs. 29% without, P<0.001). Furthermore, the likelihood of 30-day readmission for bleeding after PCI was notably elevated in patients with active cancer compared with those without (0.66% vs. 0.19%) (P<0.001). Among cancer types, breast cancer exhibited the highest readmission rates (0.78% vs. 0.33%), followed by lung cancer (0.55% vs. 0.33%), prostate cancer (0.46% vs. 0.33%), and colorectal cancer (0.34% vs. 0.33%) (P<0.001). The average time to GI bleeding readmission ranged from 9.4 days for colorectal cancer to 13.3 days for breast cancer, with an overall average of 12.7 days across all cancer types.

Conclusion: PCI in cancer patients presents a complex clinical scenario with a multidisciplinary approach, integrating cardiology, oncology, and gastroenterology expertise. Post-PCI, individuals with cancer face heightened susceptibility to readmissions due to bleeding events, with the degree of risk influenced by cancer type, sex, age, and active cancer.