Clinical Characteristics and Risk Factors of In-Hospital Mortality in Patients With Acute Myocardial Infarction With Subsequent Gastrointestinal Bleeding: A Single-Center Experience

Abstract

ObjectiveGastrointestinal bleeding (GIB) post acute myocardial infarction (AMI) is a severe clinical condition with a poor prognosis. The purpose of the study was to evaluate the rate of in-hospital mortality in patients with GIB post-AMI and to identify the potential risk factors of this situation.MethodsIn this single-center retrospective study, a total of 154 patients diagnosed with AMI who subsequently suffered GIB were enrolled from October 2013 to December 2021. Demographic, laboratory, and clinical data were collected. The in-hospital mortality was the outcome of interest. Logistic regression analysis was used to investigate the potential risk factors of in-hospital mortality.ResultsAmong the 154 subjects included in the final analysis, the mean age was 65.58 ± 11.20 years, and 104 (67.53%) were males. GIB occurred in 11 patients after thrombolytic therapy, 50 patients after percutaneous coronary intervention (PCI), and 93 patients during drug conservative treatment. A total of 41 patients died in the hospital. The in-hospital mortality rate of the thrombolysis group, PCI group, and drug conservative treatment group was 27.27% (3/11), 28.00% (14/50), and 25.81% (24/93), respectively. There was no difference in the in-hospital mortality among the three groups. The multivariate logistic regression analysis showed that the peak levels of TnI (OR 1.07, 95% CI 1.02–1.12, P = 0.011), condition of cardiogenic shock after admission (OR 14.52, 95% CI 3.36–62.62, P < 0.001), and the use of the mechanical ventilator (OR 8.14, 95% CI 2.03–32.59, P = 0.003) were significantly associated with in-hospital mortality.ConclusionRegardless of the treatment strategy for AMI, once GIB occurred, the prognosis was poor. High in-hospital mortality in patients with GIB post-AMI was independently associated with the peak levels of TnI, condition of cardiogenic shock, and the use of a mechanical ventilator.

Association between Blood Urea Nitrogen Level and In-Hospital Mortality in Patients with Acute Myocardial Infarction and Subsequent Gastrointestinal Bleeding

“…However, there are still many unknown factors that affect in-hospital outcomes in these patients. Some single-center retrospective studies have discussed potential risk factors for this situation; however, BUN has not been found to have a significant impact on in-hospital mortality in individuals with AMI complicated by GIB [ 6 , 9 , 10 ]. To our knowledge, the present study is one of the largest investigations involving AMI patients who developed GIB and reports a higher degree of certainty than previous studies.…”

“…Some studies have discussed potential risk factors in this setting [ 6 , 9 , 10 ]. In a retrospective study conducted at a single center, participants diagnosed with non-ST-segment elevation myocardial infarction (NSTEMI) and upper GIB showed that several factors may independently influence in-hospital mortality, including age, peak white blood cell count, minimum platelet count, and peak brain natriuretic peptide levels [ 10 ].…”

Acute myocardial infarction post-gastrointestinal bleeding

“…Previous studies have mainly focused on GIB post-AMI, and these findings demonstrated that GIB, including lower and upper gastrointestinal origins, was independently associated with increased mortality. [ 9 10 11 12 13 14 ] However, few studies have focused on AMI post-GIB. Although there are similar situations, the pathogenesis of the two conditions is different.…”

A review on increasing risk for gastrointestinal bleeding associated with dabigatran

“…Gastrointestinal bleeding (GIB) is a frequent cause of hospital admission and contributes to hospital morbidity and mortality [6]. Anticoagulation therapy frequently needs to be interrupted because GIB is a severe complication in patients with nonvalvular atrial fibrillation.…”