Endoscopy After Acute Myocardial Infarction
Endoscopy After Acute Myocardial Infarction
Objectives: Upper gastrointestinal bleeding in the setting of acute myocardial infarction (MI) has substantial morbidity and mortality. Several studies have been performed on the safety of esophagogastroduodenoscopy (EGD) after MI; however, these studies vary in definitions and results. We evaluated the safety and effect of EGD in patients with acute MI in a tertiary center.
Methods: A retrospective, single tertiary-care center study was undertaken of 87 patients who underwent EGD within 30 days of an acute MI between January 2001 and March 2012. Type of MI (ST segment elevation MI [STEMI] and non–ST segment elevation MI [NSTEMI]), peak troponin I, time from MI to EGD, Acute Physiology and Chronic Health Evaluation (APACHE) II score at EGD, cardiac catheterization before EGD, and medical complications within 24 hours of EGD were noted. Medical complications were defined as major complications (death, life-threatening arrhythmias) and minor complications (chest pain, abnormal vital signs, or minor arrhythmias).
Results: Eighty-seven patients underwent EGD within 30 days of having an MI. No major complications were observed. Minor complications occurred in 27 of 87 patients (31.0%), including mild hypotension, mild bradycardia, or increased chest pain. Patients with STEMI demonstrated statistically significant quicker endoscopy (P = 0.01) and were more likely to undergo cardiac catheterization in advance of EGD (P < 0.01) than those with NSTEMI. No statistically significant differences were noted for peak troponin I (P = 0.21), APACHE II score at EGD (P = 0.55), or minor complications (P = 0.08) among patients with STEMI versus NSTEMI. Cardiac catheterization before EGD did not seem to affect results. Patients with APACHE II scores >16 experienced more minor complications (P = 0.02).
Conclusions: EGD appears relatively safe for the diagnosis and management of upper gastrointestinal bleeding in patients with acute MI.
Upper gastrointestinal bleeding (UGIB) in the setting of an acute myocardial infarction (MI) presents a complex medical condition with substantial morbidity and mortality. The anemia that results from UGIB may exacerbate the MI, or the anticoagulation for the MI may contribute to UGIB. An estimated 12% of patients who present with massive UGIB experience a concomitant MI. GIB occurs in approximately 2% of patients who undergo cardiac catheterization, and nosocomial UGIB following catheterization is associated with increased risk of mortality. Given this mortality, a clinical dilemma may arise when a patient with acute MI presents with UGIB.
Esophagogastroduodenoscopy (EGD) is, in general, a safe, well-tolerated, and common procedure performed in the general population; however, the safety and utility of performing EGD in patients with acute MI are not certain and there may be a reluctance to perform EGD given the lack of guidelines and fear of complications. As with other endoscopic procedures, EGD has been associated with blood pressure fluctuations, electrocardiogram changes, drop in oxygen saturation, and hypoxemia from analgesic agents.
The decision to perform an EGD during the peri-MI period is guided by an analysis of patient benefit versus risk of cardiopulmonary complications. Several studies have evaluated the safety of EGD after MI with varying definitions and results. 1,6–10 Given the varying results of this important clinical scenario, we evaluated the safety and efficacy of EGD in patients with acute MI in our tertiary care center.
Abstract and Introduction
Abstract
Objectives: Upper gastrointestinal bleeding in the setting of acute myocardial infarction (MI) has substantial morbidity and mortality. Several studies have been performed on the safety of esophagogastroduodenoscopy (EGD) after MI; however, these studies vary in definitions and results. We evaluated the safety and effect of EGD in patients with acute MI in a tertiary center.
Methods: A retrospective, single tertiary-care center study was undertaken of 87 patients who underwent EGD within 30 days of an acute MI between January 2001 and March 2012. Type of MI (ST segment elevation MI [STEMI] and non–ST segment elevation MI [NSTEMI]), peak troponin I, time from MI to EGD, Acute Physiology and Chronic Health Evaluation (APACHE) II score at EGD, cardiac catheterization before EGD, and medical complications within 24 hours of EGD were noted. Medical complications were defined as major complications (death, life-threatening arrhythmias) and minor complications (chest pain, abnormal vital signs, or minor arrhythmias).
Results: Eighty-seven patients underwent EGD within 30 days of having an MI. No major complications were observed. Minor complications occurred in 27 of 87 patients (31.0%), including mild hypotension, mild bradycardia, or increased chest pain. Patients with STEMI demonstrated statistically significant quicker endoscopy (P = 0.01) and were more likely to undergo cardiac catheterization in advance of EGD (P < 0.01) than those with NSTEMI. No statistically significant differences were noted for peak troponin I (P = 0.21), APACHE II score at EGD (P = 0.55), or minor complications (P = 0.08) among patients with STEMI versus NSTEMI. Cardiac catheterization before EGD did not seem to affect results. Patients with APACHE II scores >16 experienced more minor complications (P = 0.02).
Conclusions: EGD appears relatively safe for the diagnosis and management of upper gastrointestinal bleeding in patients with acute MI.
Introduction
Upper gastrointestinal bleeding (UGIB) in the setting of an acute myocardial infarction (MI) presents a complex medical condition with substantial morbidity and mortality. The anemia that results from UGIB may exacerbate the MI, or the anticoagulation for the MI may contribute to UGIB. An estimated 12% of patients who present with massive UGIB experience a concomitant MI. GIB occurs in approximately 2% of patients who undergo cardiac catheterization, and nosocomial UGIB following catheterization is associated with increased risk of mortality. Given this mortality, a clinical dilemma may arise when a patient with acute MI presents with UGIB.
Esophagogastroduodenoscopy (EGD) is, in general, a safe, well-tolerated, and common procedure performed in the general population; however, the safety and utility of performing EGD in patients with acute MI are not certain and there may be a reluctance to perform EGD given the lack of guidelines and fear of complications. As with other endoscopic procedures, EGD has been associated with blood pressure fluctuations, electrocardiogram changes, drop in oxygen saturation, and hypoxemia from analgesic agents.
The decision to perform an EGD during the peri-MI period is guided by an analysis of patient benefit versus risk of cardiopulmonary complications. Several studies have evaluated the safety of EGD after MI with varying definitions and results. 1,6–10 Given the varying results of this important clinical scenario, we evaluated the safety and efficacy of EGD in patients with acute MI in our tertiary care center.
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