P2462 - Incidence and Outcomes of Gastrointestinal Bleeding in Patients With Left Ventricular Assist Device Varies Depending on Etiology of Cardiogenic Shock

Nina Quirk, MS, MD¹, Nitish Mittal, MD¹, Adishwar Rao, MD², Akriti Agrawal, MD², Shreyas Ranganath, BS³, Nirav Thosani, MD³, Bindu Akkanti, MD³, Ismael Salas de Armas, MD¹, Sriram Nathan, MD¹, Igor Gregoric, MD^1
1University of Texas Health, McGovern Medical School, Houston, TX; ²Guthrie Robert Packer Hospital, Fort Drum, NY; ³McGovern Medical School at UTHealth, Houston, TX

Introduction: Left ventricular assist devices (LVAD) have shown to improve survival in patients with cardiogenic shock. Gastrointestinal (GI) bleeding is frequently observed in these patients which could be a combination of critical illness, altered perfusion, pre-existing comorbidities, and anticoagulation and anti-platelet use. Etiology of cardiogenic shock such as acute myocardial infarction (AMI-CS) versus non-AMI cardiogenic shock (non-AMI CS) plays a critical role in medical management of these patients. The aim of our study was to explore the difference in incidence and outcomes of GI bleeding in patients with cardiogenic shock supported by LVAD (Impella 5.5 device), depending on the etiology of shock.

Methods: We conducted retrospective review of prospective maintained database of all consecutive patients undergoing LVAD placement at our institute between March 2020 and May 2023. The study was approved by institutional IRB committee. We identified 160 patients who underwent LVAD placement during the study period. We compared the overall incidence, etiology, treatment, and overall outcomes of GI bleeding between two groups (AMI-CS vs non-AMI-CS). We used student’s t-test and descriptive analysis to explore the difference between two groups.

Results: The study found no significant difference in the location of GI Bleed between the two groups. Incidences of gastritis, gastric/duodenal ulcers, and anteriovenous malformations (AVMs) were observed, but with no remarkable distinctions between AMI CS and Non-AMI CS groups. Furthermore, 77% of AMI-CS cases showed no insult compared to 85% in Non-AMI CS (p=0.20).

Median time to GI Bleed was 12 days (IQR 5-33) in AMI-CS and 10 days (IQR 3-36) in Non-AMI CS. GI Bleed recurrence ( >30 days to 6 months) was 10% in AMI-CS and 4% in Non-AMI CS. A difference in GI bleed presentation was observed between the two groups (p=0.051). Significantly higher antiplatelet use was observed in AMI-CS (p=0.001).

While 30-day survival rates were 62% in AMI-CS and 56% in Non-AMI CS with Impella 5.5 support, no statistically significant difference was noted, possibly due to the limited sample size. AMI-CS had significantly shorter time to death after LVAD placement (p=0.032). A summary of the findings can be found in Table 1.

Discussion: We observed higher re-bleeding rate in patients with LVAD for AMI-CS compared to LVAD for non-AMI CS. Larger-scale studies are essential to comprehensively understand and address the incidence of GI Bleed in this critically ill population.


Disclosures:


Nina Quirk, MS, MD¹, Nitish Mittal, MD¹, Adishwar Rao, MD², Akriti Agrawal, MD², Shreyas Ranganath, BS³, Nirav Thosani, MD³, Bindu Akkanti, MD³, Ismael Salas de Armas, MD¹, Sriram Nathan, MD¹, Igor Gregoric, MD¹. P2462 - Incidence and Outcomes of Gastrointestinal Bleeding in Patients With Left Ventricular Assist Device Varies Depending on Etiology of Cardiogenic Shock, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.