title: Acute Myocardial Infarction Risk in Patients with Coronary Artery Disease Doubled after Upper Gastrointestinal Tract Bleeding: A Nationwide Nested Case-Control Study.
abstract: Prior studies of upper gastrointestinal bleeding (UGIB) and acute myocardial infarction (AMI) are small, and long-term effects of UGIB on AMI have not been delineated. We investigated whether UGIB in patients diagnosed with coronary artery disease (CAD) increased their risk of subsequent AMI. This was a population-based, nested case-control study using Taiwan's National Health Insurance Research Database. After propensity-score matching for age, gender, comorbidities, CAD date, and follow-up duration, we identified 1,677 new-onset CAD patients with AMI (AMI[+]) between 2001 and 2006 as the case group and 10,062 new-onset CAD patients without (AMI[-]) as the control group. Conditional logistic regression was used to examine the association between UGIB and AMI. Compared with UGIB[-] patients, UGIB[+] patients had twice the risk for subsequent AMI (adjusted odds ratio [AOR] = 2.08; 95% confidence interval [CI], 1.72-2.50). In the subgroup analysis for gender and age, UGIB[+] women (AOR = 2.70; 95% CI, 2.03-3.57) and patients < 65 years old (AOR = 2.23; 95% CI, 1.56-3.18) had higher odds of an AMI. UGIB[+] AMI[+] patients used nonsignificantly less aspirin than did UGIB[-] AMI[+] patients (27.69% vs. 35.61%, respectively). UGIB increased the risk of subsequent AMI in CAD patients, especially in women and patients < 65. This suggests that physicians need to use earlier and more aggressive intervention to detect UGIB and prevent AMI in CAD patients.
authors.affiliation: Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan.
authors.forename: Chia-Jung
authors.initials: CJ
authors.lastname: Wu
authors.affiliation: Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan; Department of Emergency Medicine, Taipei Medical University, Taipei, Taiwan; Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan.
authors.forename: Hung-Jung
authors.initials: HJ
authors.lastname: Lin
authors.affiliation: Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan; Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Shih-Feng
authors.initials: SF
authors.lastname: Weng
authors.affiliation: Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan; Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan.
authors.forename: Chien-Chin
authors.initials: CC
authors.lastname: Hsu
authors.affiliation: Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan.
authors.forename: Jhi-Joung
authors.initials: JJ
authors.lastname: Wang
authors.affiliation: Department of Occupational Medicine, Chi-Mei Medical Center, Tainan, Taiwan; Department of Leisure, Recreation and Tourism Management, Southern Taiwan University of Science and Technology, Tainan, Taiwan; Department of Medical Research, Chi Mei Medical Center, Liouying, Tainan, Taiwan.
authors.forename: Shih-Bin
authors.initials: SB
authors.lastname: Su
authors.affiliation: Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan; Department of Occupational Medicine, Chi-Mei Medical Center, Tainan, Taiwan; Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Child Care and Education, Southern Taiwan University of Science and Technology, Tainan, Taiwan; Department of Geriatrics and Geronotology, Chi-Mei Medical Center, Tainan, Taiwan.
authors.forename: Chien-Cheng
authors.initials: CC
authors.lastname: Huang
authors.affiliation: Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
authors.forename: How-Ran
authors.initials: HR
authors.lastname: Guo
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000150:complications / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000150:complications / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000209:etiology; D012042:Registries; D012307:Risk Factors; D012737:Sex Factors; D013624:Taiwan / Q000453:epidemiology