Upper Endoscopy in Patients with Acute Myocardial Infarction and Upper Gastrointestinal Bleeding: Results of a Decision Analysis

Overview

Journal Dig Dis Sci

Specialty Gastroenterology

Date 2008 Jul 29

PMID 18661236

Citations 14

Authors

Patrick Yachimski

Chin Hur

Affiliations

Soon will be listed here.

Abstract

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.

Aim: 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.

Citing Articles

Which Comes First, the Scope or the Cath? Timing of Endoscopy in Patients with Non-variceal Upper Gastrointestinal Bleeding and Non-ST Elevation Myocardial Infarction.

Ryan-Fisher C, Birk J Dig Dis Sci. 2023; 68(10):3841-3842.

PMID: 37620713 DOI: 10.1007/s10620-023-08040-x.

Delaying Cardiac Catheterization in Favor of Endoscopy in Non-ST Elevation Myocardial Infarction Patients Is Associated with Worse Outcomes: A Nationwide Analysis.

Ali H, Patel P, Lowell J, Dahiya D, Singh S, Hammami A Dig Dis Sci. 2023; 68(10):3913-3920.

PMID: 37620712 DOI: 10.1007/s10620-023-08033-w.

Outcomes of Hospitalized Patients With Fecal Occult Positive Stool Prior to Cardiac Catheterization in Acute Coronary Syndrome (ACS).

Searls L, Annie F, Tomanguillo J, Campbell J, Kemper S, Naravadi V Cureus. 2023; 15(1):e34263.

PMID: 36855492 PMC: 9968416. DOI: 10.7759/cureus.34263.

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Zhang Y, Liu H, Liu X Heliyon. 2022; 8(11):e11638.

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The Clinical Dilemma of Esophagogastroduodenoscopy for Gastrointestinal Bleeding in Cardiovascular Disease Patients: A Nationwide-Based Retrospective Study.

Chang C, Chien W, Chung C, Lin H, Huang T, Chen P J Clin Med. 2022; 11(13).

PMID: 35807050 PMC: 9267236. DOI: 10.3390/jcm11133765.

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