GI bleeding complicating PCI: Trends, outcomes, and a paradoxical decline in endoscopy utilization.

BACKGROUND: Gastrointestinal bleeding (GIB) is a feared complication of percutaneous coronary intervention (PCI), carrying significant morbidity and mortality. Updated national data on trends in prevalence, management patterns, and outcomes across patient subgroups are lacking. METHODS: We analyzed the National Inpatient Sample (2016-2022), identifying ACS/CAD-related PCI admissions with GIB using ICD-10-CM codes. Survey-weighted multivariable logistic regression adjusted for demographics, comorbidities, and hospital characteristics. Inverse probability of treatment weighting (IPTW) served as the primary sensitivity analysis. Temporal trends in GIB prevalence, subtype, endoscopy use, and transfusion rates were assessed by calendar year. RESULTS: Among 3,231,885 weighted PCI admissions, GIB occurred in approximately 2.1%. GIB was associated with higher in-hospital mortality (multivariable adjusted odds ratio [aOR] 3.393; IPTW aOR 5.165; both P < 0.001), with lower GIB carrying higher mortality than upper GIB (aOR 3.069 vs 1.581). GIB was also associated with 5.42 additional hospital days and $18,974 higher costs after IPTW adjustment (both P < 0.001). Despite stable prevalence, upper endoscopy use declined significantly (OR per year 0.959, P = 0.006) and was independently associated with lower mortality (aOR 0.702, 95% CI 0.587-0.839), P < 0.001). Black and Hispanic patients had higher odds of GIB (all aOR >1.2, P < 0.001). CONCLUSIONS: GIB complicates approximately 1 in 50 PCI admissions and is associated with substantially higher mortality, prolonged hospitalization, and excess costs. Declining endoscopy utilization despite an observed mortality benefit may represent a quality improvement opportunity. Higher mortality associated with lower GIB warrants further investigation.