title: Silent myocardial ischemia in coronary artery disease patients under aspirin therapy presenting with upper gastrointestinal hemorrhage.
abstract: OBJECTIVE
  To identify the risk factors for myocardial ischemia in patients undergoing aspirin therapy for coronary artery disease (CAD) presenting with upper gastrointestinal hemorrhage and to ascertain the impacts on mortality and length of hospital stay.
  
  
  METHODS
  Adults with CAD under aspirin therapy (100 mg once daily) presenting to the emergency department with upper gastrointestinal hemorrhage were retrospectively recruited and divided into group A (ischemia) and group B (non-ischemia). Charts were reviewed for various demographic, laboratory and outcome data. Electrocardiograms were interpreted blindly by a senior cardiologist.
  
  
  RESULTS
  A total of 152 patients, 72.4% men and 27.6% women, were analyzed. Of these, 31 patients had ischemia and were placed in group A and 121 patients did not have ischemia and were in group B. Independent multivariate predictors of myocardial ischemia were history of triple vessel disease (odds ratio [OR], 9.24; 95% confidence interval [CI], 2.00-42.72), lower diastolic blood pressure (OR, 1.09; 95% CI, 1.02-1.16), lower hematocrit (OR, 1.41; 95% CI, 1.16-1.70), and higher blood urea nitrogen (OR, 0.94; 95% CI, 0.89-0.98). Patients with myocardial ischemia had significantly longer hospital length of stay (8.7 +/- 4.0 days vs 5.4 +/- 1.7 days; P < 0.001) and higher in-hospital mortality (16.1%vs 2.5%; P < 0.01) than did those without myocardial ischemia.
  
  
  CONCLUSIONS
  Myocardial ischemia is a relatively common complication in CAD patients under aspirin therapy presenting with upper gastrointestinal hemorrhage. A history of CAD with triple vessel disease, higher blood urea nitrogen, lower diastolic blood pressure and lower hematocrit may help identify patients who are at increased risk of myocardial ischemia, which tends to be associated with higher in-hospital mortality and increased length of hospital stay.
authors.affiliation: Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Chien-Chih
authors.initials: CC
authors.lastname: Chen
authors.forename: Chee-Fah
authors.initials: CF
authors.lastname: Chong
authors.forename: Cheng-Deng
authors.initials: CD
authors.lastname: Kuo
authors.forename: Tzong-Luen
authors.initials: TL
authors.lastname: Wang
mesh_terms: D000368:Aged; D001241:Aspirin / Q000009:adverse effects*; D003327:Coronary Disease / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D004562:Electrocardiography; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced / Q000150:complications* / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D017202:Myocardial Ischemia / Q000209:etiology* / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D001241:Aspirin