Upper endoscopy in patients with acute myocardial infarction and upper gastrointestinal bleeding: results of a decision analysis.
BACKGROUND
The management of patients with acute myocardial infarction (AMI) and upper gastrointestinal bleeding (UGIB) can present a challenge. The utility of upper endoscopy (esophagogastroduodenoscopy, EGD) and endoscopic therapy must be weighed against safety considerations.


OBJECTIVE
To assess the utility and safety of EGD in patients with UGIB and AMI.


METHODS
Using decision analysis, patients with UGIB and AMI were assigned to one of two strategies: (1) EGD prior to cardiac catheterization (EGD strategy) and (2) cardiac catheterization without EGD (CATH strategy).


RESULTS
In patients with overt UGIB, the EGD strategy resulted in 97 deaths per 10,000 patients, compared with 600 deaths in the CATH strategy. The EGD strategy resulted in fewer non-fatal complications (1,271 vs. 6,000 per 10,000 patients). In patients with occult blood loss, the EGD strategy resulted in more deaths (59 vs. 16 per 10,000) and more non-fatal complications (888 vs. 160 per 10,000) than the CATH strategy.


CONCLUSIONS
Our analysis supports EGD prior to cardiac catheterization in patients with AMI and overt UGIB. This strategy results in fewer deaths and complications compared with a strategy of proceeding directly to catheterization. Our analysis does not support routine EGD prior to cardiac catheterization in patients with fecal occult blood.
Yachimski
Patrick
P
Blake 4 Gastrointestinal Unit, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA. pyachimski@partners.org
Hur
Chin
C
D015906:Angioplasty, Balloon, Coronary; D006328:Cardiac Catheterization; D003661:Decision Support Techniques; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects; D004945:Esophagoscopy / Q000009:adverse effects; D006471:Gastrointestinal Hemorrhage / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D008954:Models, Biological; D009203:Myocardial Infarction / Q000150:complications* / Q000628:therapy; D012189:Retrospective Studies; D016896:Treatment Outcome