Higher Gastrin-17 and PRECISE-DAPT Scores Predict Upper GI Bleeding Risk After PCI with DAPT

Patients with Acute Coronary Syndrome (ACS) often undergo percutaneous coronary intervention (PCI) and require dual antiplatelet therapy (DAPT) to prevent thrombotic events. However, DAPT significantly increases the risk of upper gastrointestinal bleeding (UGIB), a serious complication. Current risk stratification tools are imperfect, and there's a need for better predictive biomarkers. Serum Gastrin-17 (G-17) and pepsinogen (PG) are known indicators of gastric mucosal health, but their utility in predicting DAPT-associated UGIB in ACS patients post-PCI has been unclear.

This retrospective, single-center study analyzed 334 patients with ACS who underwent PCI and received DAPT between 2021 and 2023. Patients were divided into a UGIB group (69 patients) and a non-UGIB group (265 patients). Clinical and laboratory data, including serum G-17 and PG levels, were collected. Researchers used multivariate logistic regression and ROC curve analysis to assess the predictive value of G-17, PRECISE-DAPT scores, ACS subtype, and the specific P2Y12 receptor antagonist used (e.g., ticagrelor) for UGIB risk.

Compared to the non-UGIB group, patients in the UGIB group exhibited markedly higher Gastrin-17 levels and PRECISE-DAPT scores (p < 0.001). Additionally, ticagrelor was prescribed more commonly in the UGIB cohort (p < 0.001). The predictive power, assessed by the area under the curve (AUC), was 0.734 for G-17 alone and 0.794 for PRECISE-DAPT scores alone. When combined, their AUC increased to 0.844. > The AUC further improved to 0.878 after incorporating ticagrelor exposure, demonstrating superior exploratory value for identifying high-risk UGIB patients (p < 0.05). Furthermore, the concurrent use of proton pump inhibitors (PPIs) during DAPT significantly reduced the incidence of UGIB (34.78% vs. 65.22%, p < 0.05), highlighting PPIs as an important confounding factor for G-17 assessment.