Predictive Value of Serum Pepsinogen and Gastrin-17 in Patients With Acute Coronary Syndrome for Post-Percutaneous Coronary Intervention Oral Dual Antiplatelet Therapy-Associated Upper Gastrointestinal Bleeding.

BACKGROUND

Gastrin-17 (G-17) and serum pepsinogen (PG) are indicators that reflect the structure and function of the stomach mucosa. Although they have been linked to upper gastrointestinal bleeding (UGIB) in peptic ulcer disease, it is unknown how they relate to the risk of UGIB in patients with acute coronary syndrome (ACS) after dual antiplatelet treatment (DAPT) following percutaneous coronary intervention (PCI).

OBJECTIVE

This single-center, retrospective study aims to evaluate whether PG and G-17 as gastric mucosal assessment markers, are potentially associated with UGIB during DAPT following PCI in patients with ACS.

METHODS

This study employed a retrospective analysis design and included 334 patients with ACS (2021-2023) from Xuzhou Medical University Affiliated Hospital, divided into UGIB group (69 patients) and non-UGIB group (265 patients). Clinical and laboratory data were collected. Multivariate logistic regression and ROC curve analysis were used to evaluate the associations of G-17, PRECISE-DAPT scores, ACS subtype, and P2Y12 receptor antagonist used for UGIB after DAPT.

RESULTS

Compared with the non-UGIB group, G-17 levels and PRECISE-DAPT scores in the UGIB group were markedly higher, and ticagrelor was prescribed more commonly (p < 0.001). The area under the curve (AUC) of G-17, PRECISE-DAPT scores alone, and in combination were 0.734, 0.794, and 0.844, respectively; the AUC further increased to 0.878 after incorporating ticagrelor exposure, indicating that the combined assessment with ticagrelor exposure has superior exploratory value in identifying high-risk patients with UGIB (p < 0.05). Furthermore, the combined use of PPIs during DAPT reduced the incidence of UGIB (34.78% vs. 65.22%, p < 0.05), which serves as an important interfering factor for G-17 assessment.

CONCLUSION

Higher G-17 levels and PRECISE-DAPT scores were associated with UGIB during DAPT after PCI. Combined assessment with ticagrelor exposure showed exploratory value for identifying patients at higher bleeding risk, although PPIs use influenced model performance. Given the retrospective single-center design and limited sample size, these findings remain preliminary and require prospective multicenter validation.