Lim Roxanne G, Cobell William J, Theivanayagam Shoba, Kilgore Todd W, Matteson Michelle L, Puli Srinivas R, Bechtold Matthew L
From the University of Missouri School of Medicine, Columbia.
South Med J. 2013 Oct;106(10):545-9. doi: 10.1097/SMJ.0000000000000001.
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.
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).
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).
EGD appears relatively safe for the diagnosis and management of upper gastrointestinal bleeding in patients with acute MI.
急性心肌梗死（MI）背景下的上消化道出血具有较高的发病率和死亡率。已经有多项关于MI后食管胃十二指肠镜检查（EGD）安全性的研究；然而，这些研究在定义和结果上存在差异。我们在一家三级中心评估了EGD对急性MI患者的安全性和效果。
对2001年1月至2012年3月期间在急性MI后30天内接受EGD的87例患者进行了一项回顾性单中心三级护理研究。记录MI类型（ST段抬高型MI [STEMI]和非ST段抬高型MI [NSTEMI]）、肌钙蛋白I峰值、从MI到EGD的时间、EGD时的急性生理与慢性健康状况评估（APACHE）II评分、EGD前的心脏导管检查以及EGD后24小时内的医疗并发症。医疗并发症被定义为主要并发症（死亡、危及生命的心律失常）和次要并发症（胸痛、生命体征异常或轻微心律失常）。
87例患者在MI后30天内接受了EGD。未观察到主要并发症。87例患者中有27例（31.0%）出现次要并发症，包括轻度低血压、轻度心动过缓或胸痛加重。与NSTEMI患者相比，STEMI患者的内镜检查时间在统计学上显著更快（P = 0.01），并且更有可能在EGD前进行心脏导管检查（P < 0.01）。STEMI患者与NSTEMI患者在肌钙蛋白I峰值（P = 0.21）、EGD时的APACHE II评分（P = 0.55）或次要并发症（P = 0.08）方面未观察到统计学上的显著差异。EGD前的心脏导管检查似乎不影响结果。APACHE II评分>16的患者出现更多次要并发症（P = 0.02）。
对于急性MI患者上消化道出血的诊断和管理，EGD似乎相对安全。
