Emenike E, Srivastava S, Amoateng-Adjepong Y, al-Kharrat T, Zarich S, Manthous C A
Division of Pulmonary and Critical Care Medicine, Bridgeport Hospital, CT 06610, USA.
Mayo Clin Proc. 1999 Mar;74(3):235-41. doi: 10.4065/74.3.235.
To determine the frequency of and risk factors for myocardial infarction (MI) in patients admitted to an intensive-care unit (ICU) with gastrointestinal (GI) hemorrhage and to ascertain the effects on mortality and lengths of stay.
Demographic, laboratory, and outcome data were determined for all patients admitted to a medical ICU with GI hemorrhage between April 1996 and January 1997. Serial creatine kinase with isoenzyme levels and electrocardiograms were interpreted blindly by a senior cardiologist.
For 83 consecutive admissions to the ICU because of GI hemorrhage, the patients' mean (+/- standard error) age was 65.0 +/- 1.7 years and APACHE II (acute physiology and chronic health evaluation) score was 15.7 +/- 0.8. In-hospital death occurred in 16 patients (19%). Patients who did not survive had a lower admission systolic blood pressure (99.2 +/- 4.5 versus 115.0 +/- 4.0 mm Hg; P = 0.01) than did those who survived. Eleven of 83 patients (13%) fulfilled both enzymatic and electrocardiographic criteria for MI. Ten patients (12%) had electrocardiographic evidence of myocardial ischemia but did not meet criteria for MI. Patients with MI were older (74.4 +/- 4.0 versus 61.7 +/- 2.0 years; P < 0.05), had a higher acuity of illness (APACHE II score, 21.6 +/- 3.0 versus 14.6 +/- 0.7; P < 0.05), and had more coronary risk factors (2.3 +/- 0.3 versus 1.4 +/- 0.1; P < 0.05) in comparison with those without MI or ischemia. Patients with MI also had longer ICU (8.6 +/- 2.4 versus 3.3 +/- 0.4 days; P < 0.05) and hospital (16.3 +/- 3.4 versus 9.1 +/- 0.8 days; P < 0.05) lengths of stay. Patients older than 65 years had a threefold increased risk (risk ratio, 4.0; 95% confidence interval, 0.9 to 17.4) and those with two or more risk factors for coronary artery disease had a ninefold increased risk of MI (risk ratio, 10.2; 95% confidence interval, 1.4 to 76.1) in comparison with those who were younger or who had fewer coronary risk factors, respectively. MI complicating GI hemorrhage did not significantly affect the risk of in-hospital mortality (risk ratio, 1.5; 95% confidence interval, 0.5 to 4.4).
MI occurs frequently in patients with GI hemorrhage admitted to an ICU. Age more than 65 years and two or more risk factors for coronary artery disease identify patients who are at greatest risk for occurrence of MI, which is associated with longer ICU and hospital stays.
确定因胃肠道（GI）出血入住重症监护病房（ICU）的患者发生心肌梗死（MI）的频率及危险因素，并确定其对死亡率和住院时间的影响。
确定1996年4月至1997年1月间因GI出血入住内科ICU的所有患者的人口统计学、实验室及转归数据。由一位资深心脏病专家对连续的肌酸激酶及其同工酶水平和心电图进行盲法解读。
因GI出血连续83次入住ICU的患者，平均（±标准误）年龄为65.0±1.7岁，急性生理与慢性健康状况评分系统（APACHE II）评分为15.7±0.8。16例患者（19%）院内死亡。未存活患者的入院收缩压（99.2±4.5 vs 115.0±4.0 mmHg；P = 0.01）低于存活患者。83例患者中有11例（13%）符合MI的酶学和心电图标准。10例患者（12%）有心肌缺血的心电图证据但不符合MI标准。与无MI或心肌缺血的患者相比，发生MI的患者年龄更大（74.4±4.0 vs 61.7±2.0岁；P < 0.05），病情严重程度更高（APACHE II评分，21.6±3.0 vs 14.6±0.7；P < 0.05），且有更多的冠状动脉危险因素（2.3±0.3 vs 1.4±0.1；P < 0.05）。发生MI的患者ICU住院时间（8.6±2.4 vs 3.3±0.4天；P < 0.05）和住院时间（16.3±3.4 vs 9.1±0.8天；P < 0.05）也更长。与年龄小于65岁或冠状动脉危险因素较少的患者相比，年龄大于65岁的患者发生MI的风险增加3倍（风险比，4.0；95%置信区间，0.9至17.4），有两个或更多冠状动脉疾病危险因素的患者发生MI的风险增加9倍（风险比，10.2；95%置信区间，1.4至76.1）。并发GI出血的MI对院内死亡风险无显著影响（风险比，1.5；95%置信区间，0.5至4.4）。
因GI出血入住ICU的患者中MI很常见。年龄大于65岁以及有两个或更多冠状动脉疾病危险因素可识别出发生MI风险最高的患者，MI与更长的ICU住院时间和住院时间相关。
