Endoscopy After Acute Myocardial Infarction

Lim, Roxanne; Cobell, William J.; Theivanayagam, Shoba; Kilgore, Todd W.; Matteson, Michelle; Puli, Srinivas R.; Bechtold, Matthew L.

doi:10.1097/smj.0000000000000001

Cited by 9 publications

(4 citation statements)

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“…We suspect that this may be related to concerns from clinicians that the risks of the EGD may outweigh the benefit in these populations, in spite of the overall low complication rate of 0.5 % [26–28]. Further, several studies have suggested that EGD performed for active bleeding within 30 days of myocardial infarction can be completed safely without significant added risk [29, 30]. Conversely, these groups of patients may be the least likely to tolerate an EVB due to their underlying cardiac and respiratory disease and consequently may derive more benefit from the prevention of an EVB then those with normal cardiac and lung function.…”

Section: Discussionmentioning

confidence: 99%

Facility- and Patient-Level Factors Associated with Esophageal Variceal Screening in the USA

et al. 2015

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Background and Aim The American Association for the Study of Liver Disease (AASLD) recommends screening for esophageal varices (EV) by esophagoduodenoscopy (EGD) in patients with cirrhosis to guide decisions regarding primary prophylaxis for EV hemorrhage. We aimed to identify patient and facility factors associated with EV screening in veterans with hepatitis C (HCV)-associated cirrhosis. Methods This was a population-based cohort study. Veterans with HCV and newly diagnosed cirrhosis between 1/1/2004 and 12/31/2005 and followed until 12/31/2011 were included. The primary outcome was receipt of EGD within 1 year of cirrhosis diagnosis. Patient- and facility-level factors associated with EV screening were determined. Results A total of 4230 patients with HCV cirrhosis were identified. During median follow-up of 6.1 years (IQR: 4.0–8.0), 21.5 % developed a decompensating event, and 38.3 % died. Fifty-four percent received an EGD, and 33.8 % had an EGD within guidelines. Median time from cirrhosis diagnosis to EGD was 72 days (IQR: 12–176). Factors independently associated with receipt of EV screening were a decompensation event (OR 1.16, CI 1.01–1.32) and gastroenterology/hepatology clinic access (OR 2.1, CI 1.73–2.46), whereas cardiovascular (OR 0.81, CI 0.69–0.95), mental health (OR 0.79, CI 0.68–0.91), and respiratory (OR 0.85, CI 0.72–0.99) comorbidities were associated with reduced likelihood of EV screening. Conclusion EV screening per AASLD guidelines occurs in only one-third of patients. This missed opportunity was strongly associated with access to gastroenterology/hepatology specialty care. Additionally, providers may be relying on clinical cues (i.e., decompensation) to prompt referral for endoscopy suggesting education to improve compliance with guidelines is needed.

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Section: Discussionmentioning

confidence: 99%

Facility- and Patient-Level Factors Associated with Esophageal Variceal Screening in the USA

et al. 2015

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“…Secondly, in our study, few patients underwent endoscopy. Although some studies have shown that endoscopic treatment of GIB in AMI patients is relatively safe,[ 27 28 29 ] clinicians usually choose relatively conservative therapy to avoid medical disputes. In addition, these patients usually received conservative treatment, so there were little coronary angiography data in the record.…”

Section: Discussionmentioning

confidence: 99%

Acute myocardial infarction post-gastrointestinal bleeding: A clinical dilemma with poor prognosis

Wei

et al. 2023

Saudi J Gastroenterol

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Background: Gastrointestinal bleeding (GIB) complicating acute myocardial infarction (AMI) is a severe clinical condition with treatment contradiction and poor prognosis. This study aimed to evaluate the rate of in-hospital mortality in patients with GIB who subsequently suffered from AMI and to explore the potential risk factors for this condition. Methods: In this retrospective study, a total of 77 patients diagnosed with GIB, who subsequently suffered from AMI, were enrolled from January 2013 to March 2022. Demographic, laboratory, and clinical data were collected. The in-hospital mortality was the outcome of interest. Logistic regression analysis was used to investigate the potential risk factors of in-hospital mortality. Results: Among the 77 patients included in this study, 62 (80.52%) were males. The mean age of patients was 65.88 ± 12.15 years, and 48 patients (62.34%) were non-ST-segment elevation myocardial infarction (NSTEMI). There were 16 (20.78%) cases of in-hospital deaths. The subjects who died showed higher levels of white blood cell count (13.05 ± 5.76 vs. 9.31 ± 4.07 × 10 9 /L, P = 0.003) and troponin I (TnI) (9.23 ± 9.17 vs. 4.12 ± 5.03 μg/L, P = 0.003). Besides, there were higher proportions of cardiogenic shock (81.25% vs. 26.23%, P < 0.001) and mechanical ventilator usage (75.0% vs. 11.48%, P < 0.001) among the patients who died. The multivariate logistic regression analysis showed that white blood cell count (odds ratio [OR] 1.19, 95% confidence interval [CI] 1.02–1.39, P = 0.030), cardiogenic shock (OR 12.18, 95% CI 3.06–48.39, P = 0.017), and mechanical ventilator usage (OR 7.21, 95% CI 1.28–40.51, P = 0.025) were independently associated with in-hospital mortality. Conclusions: The in-hospital mortality of patients with GIB who subsequently develop AMI is high. White blood cell count, cardiogenic shock, and mechanical ventilator usage are independent predictors of in-hospital mortality.

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“…Secondly, few patients underwent endoscopy in our study. Although some studies have pointed out that endoscopic treatment of GIB in patients with AMI is relatively safe (36)(37)(38), doctors usually choose relatively conservative treatment in order to avoid medical disputes. In addition, since we do not have the endoscopy results of these patients, the origin (lower and upper) of the GIB is unclear.…”

Section: Discussionmentioning

confidence: 99%

Clinical Characteristics and Risk Factors of In-Hospital Mortality in Patients With Acute Myocardial Infarction With Subsequent Gastrointestinal Bleeding: A Single-Center Experience

Wei

Pang

et al. 2022

Front. Cardiovasc. Med.

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ObjectiveGastrointestinal bleeding (GIB) post acute myocardial infarction (AMI) is a severe clinical condition with a poor prognosis. The purpose of the study was to evaluate the rate of in-hospital mortality in patients with GIB post-AMI and to identify the potential risk factors of this situation.MethodsIn this single-center retrospective study, a total of 154 patients diagnosed with AMI who subsequently suffered GIB were enrolled from October 2013 to December 2021. Demographic, laboratory, and clinical data were collected. The in-hospital mortality was the outcome of interest. Logistic regression analysis was used to investigate the potential risk factors of in-hospital mortality.ResultsAmong the 154 subjects included in the final analysis, the mean age was 65.58 ± 11.20 years, and 104 (67.53%) were males. GIB occurred in 11 patients after thrombolytic therapy, 50 patients after percutaneous coronary intervention (PCI), and 93 patients during drug conservative treatment. A total of 41 patients died in the hospital. The in-hospital mortality rate of the thrombolysis group, PCI group, and drug conservative treatment group was 27.27% (3/11), 28.00% (14/50), and 25.81% (24/93), respectively. There was no difference in the in-hospital mortality among the three groups. The multivariate logistic regression analysis showed that the peak levels of TnI (OR 1.07, 95% CI 1.02–1.12, P = 0.011), condition of cardiogenic shock after admission (OR 14.52, 95% CI 3.36–62.62, P < 0.001), and the use of the mechanical ventilator (OR 8.14, 95% CI 2.03–32.59, P = 0.003) were significantly associated with in-hospital mortality.ConclusionRegardless of the treatment strategy for AMI, once GIB occurred, the prognosis was poor. High in-hospital mortality in patients with GIB post-AMI was independently associated with the peak levels of TnI, condition of cardiogenic shock, and the use of a mechanical ventilator.

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Endoscopy After Acute Myocardial Infarction

Abstract: EGD appears relatively safe for the diagnosis and management of upper gastrointestinal bleeding in patients with acute MI.

Cited by 9 publications

References 10 publications

Facility- and Patient-Level Factors Associated with Esophageal Variceal Screening in the USA

Facility- and Patient-Level Factors Associated with Esophageal Variceal Screening in the USA

Acute myocardial infarction post-gastrointestinal bleeding: A clinical dilemma with poor prognosis

Clinical Characteristics and Risk Factors of In-Hospital Mortality in Patients With Acute Myocardial Infarction With Subsequent Gastrointestinal Bleeding: A Single-Center Experience

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