Factors associated with myocardial infarction after emergency endoscopy for upper gastrointestinal bleeding in high-risk patients: a prospective observational study

Lee, Ching-Tai; Huang, Shih-Pei; Cheng, Tsu-Yao; Chiang, Tsung-Hsien; Tai, Chi-Ming; Su, Wei-Chih; Huang, Chien-Hua; Lin, Jaw-Town; Wang, Hsiu-Po

doi:10.1016/j.ajem.2006.04.013

« Previous Next »American Journal of Emergency Medicine
Volume 25, Issue 1 , Pages 49-52, January 2007

Factors associated with myocardial infarction after emergency endoscopy for upper gastrointestinal bleeding in high-risk patients: a prospective observational study

Ching-Tai Lee, MD
- Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan
Shih-Pei Huang, MD, PhD
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
Tsu-Yao Cheng, MD
- Department of Laboratory Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
Tsung-Hsien Chiang, MD
- Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan
Chi-Ming Tai, MD
- Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan
Wei-Chih Su, MD
- Department of Gastroenterology, Buddist Tzu Chi General Hospital Taipei Branch, Taipei, Taiwan
Chien-Hua Huang, MD
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
Jaw-Town Lin, MD, PhD
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
Hsiu-Po Wang, MD
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
- Corresponding address. Hsiu-Po Wang, MD, Department of Emergency Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan. Tel.: +886 2 23123456x5695; fax: +886 2 23947899.

Received 29 March 2006; received in revised form 30 April 2006; accepted 30 April 2006.

Abstract

Background

Because myocardial infarction (MI) after emergency endoscopy for upper gastrointestinal bleeding carries high mortality, we investigated factors associated with procedure-related MI in high-risk patients.

Methods

Consecutive patients with coronary artery disease or age-based risk for coronary artery disease (men, age >45 years; women, >55 years) who underwent emergency endoscopy were enrolled at a single ED. Demographic, laboratory, and outcome data were recorded. Patients fit 1 of 3 groups: MI before endoscopy (pre-panendoscopy [PES] MI), MI after endoscopy (post-PES MI), or non-MI.

Results

We enrolled 108 high-risk patients, including 5 (4.6%) with MI diagnosed preendoscopy. Five patients (4.6%) had MIs postendoscopy. Compared with non-MI patients, significantly more post-PES MI patients had heart disease (60.0% vs 12.2%; P = .021), lower systolic pressure on arrival (86.2 ± 16.6 vs 128.0 ± 27.2 mm Hg; P = .002), lower diastolic pressure on arrival (50.0 ± 6.3 vs 69.5 ± 15.8 mm Hg; P = .003), lower hemoglobin on arrival (6.7 ± 1.1 vs 9.1 ± 2.4 g/dL; P = .021), and more persistent shock status preendoscopy (80.0% vs 13.3%; P = .002). There was no significant difference in factors including duration of procedure and rates of recurrent bleeding, postprocedure complication, and mortality.

Conclusions

Heart disease, lower blood pressure or hemoglobin level on arrival, and persistent shock before endoscopy are associated with increased risk for procedure-related MI.