title: The utility of upper endoscopy in patients with concomitant upper gastrointestinal bleeding and acute myocardial infarction.
abstract: Patients who present with upper gastrointestinal bleeding (UGIB) in the setting of acute myocardial infarction (AMI) may have suffered an UGIB that subsequently led to an AMI or endured an AMI and subsequently suffered a UGIB as a consequence of anticoagulation. We hypothesized that patients in the former group bled from more severe upper tract lesions. The aim of this study was to evaluate predictors for endoscopic therapy in patients who suffer a concomitant UGIB and AMI. Retrospective, single center medical record abstraction of hospital admissions from January 1, 1996-December 31, 2002. During the study period, 183 patients underwent an esophagogastroduodenoscopy (EGD) within 7 days of suffering an AMI and UGIB (AMI group N=105, UGIB group N=78). A higher proportion of patients in the UGIB group (41%) was found to have high-risk UGI lesions requiring endoscopic treatment compared to patients in the AMI group (17%; P < 0.004). UGIB as the inciting event and patients suffering from hematemesis and hemodynamic instability were significantly associated with requiring endoscopic therapy. Although predominantly diagnostic, endoscopic findings in the AMI group did alter the decision to perform cardiac catheterization in 43% of patients. Severe complications occurred in 1% (95% confidence interval, 0%-4%) of patients. We conclude that in patients suffering from concomitant UGIB and AMI, urgent endoscopy was most beneficial in patients with UGIB as the initial event and those presenting with hematemesis and hemodynamic instability. In patients without these clinical features, urgent endoscopy may be delayed, unless cardiac management decisions are dependent on endoscopic findings.
authors.affiliation: Division of Gastroenterology, Department of Medicine, Durham, North Carolina, USA. lins@tmfhs.org
authors.forename: Sauyu
authors.initials: S
authors.lastname: Lin
authors.forename: Richard
authors.initials: R
authors.lastname: Konstance
authors.forename: James
authors.initials: J
authors.lastname: Jollis
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Fisher
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects; D006328:Cardiac Catheterization; D016001:Confidence Intervals; D003657:Decision Making; D016145:Endoscopy, Digestive System / Q000009:adverse effects / Q000706:statistics & numerical data*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000150:complications* / Q000175:diagnosis* / Q000503:physiopathology; D006396:Hematemesis / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000175:diagnosis* / Q000503:physiopathology; D012189:Retrospective Studies
chemical_list: D000925:Anticoagulants