Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
Am J Gastroenterol. 2020 Mar;115(3):376-380. doi: 10.14309/ajg.0000000000000528.
Patients hospitalized with myocardial infarction (MI) are at risk of gastrointestinal bleeding because of the need for antiplatelet agents and/or anticoagulation. The data regarding the safety of endoscopy after MI are limited. This study sought to assess mortality rates of patients hospitalized with acute MI who require esophagogastroduodenoscopy or colonoscopy using the National Inpatient Sample (NIS) database.
A retrospective cohort analysis of all adult inpatients in the NIS from 2016 admitted for ST-elevation infarction myocardial infarction (STEMI), non-STEMI, or type II non-STEMI was conducted. Data were collected including patient demographics and indication for endoscopy per ICD-10 coding. HCUPnet was used to query NIS to obtain all inpatient mortality. The primary methods included adjusted χ for categorical outcomes, adjusted linear regression for continuous outcomes, and adjusted logistic regression for multivariable analysis.
A total of 1,281,749 patients were admitted for acute coronary syndrome in 2016, and 55,035 of these patients underwent endoscopy In the multivariable regression analysis, those who underwent a GI procedure (odds ratio [OR] 0.80, P value < 0.002) and angiogram (OR 0.48, P value < 0.001) had lower in-hospital mortality, after adjusting for age, Elixhauser index, need for angiogram, sex, race, and hospital type. Endoscopy postcatheterization was not associated with a difference in mortality compared with preangiogram (OR = 0.84, 95% confidence interval 0.60-1.19).
Patients who underwent endoscopy are sicker and have higher mortality rates than those who do not undergo endoscopy, but after adjusting for comorbidities, mortality is actually lower. This suggests that endoscopy is safe and should be performed when clinically indicated despite recent cardiac ischemia.
由于需要使用抗血小板药物和/或抗凝药物，因心肌梗死（MI）住院的患者有发生胃肠道出血的风险。有关 MI 后内镜检查安全性的数据有限。本研究旨在使用国家住院患者样本（NIS）数据库评估因急性 MI 住院且需要进行食管胃十二指肠镜检查或结肠镜检查的患者的死亡率。
对 NIS 中 2016 年所有因 ST 段抬高型心肌梗死（STEMI）、非 ST 段抬高型心肌梗死或 II 型非 ST 段抬高型心肌梗死住院的成年住院患者进行回顾性队列分析。收集的数据包括患者人口统计学资料和根据 ICD-10 编码的内镜检查指征。使用 HCUPnet 查询 NIS 以获取所有住院患者的死亡率。主要方法包括分类变量的调整 χ2检验、连续变量的调整线性回归和多变量分析的调整逻辑回归。
2016 年共有 1281749 例患者因急性冠状动脉综合征住院，其中 55035 例患者接受了内镜检查。在多变量回归分析中，与未接受 GI 操作的患者相比，接受 GI 操作（比值比 [OR] 0.80，P 值 < 0.002）和血管造影术（OR 0.48，P 值 < 0.001）的患者住院死亡率较低，调整年龄、Elixhauser 指数、血管造影术需求、性别、种族和医院类型后。与血管造影前相比，血管造影后内镜检查与死亡率无差异（OR = 0.84，95%置信区间 0.60-1.19）。
接受内镜检查的患者比未接受内镜检查的患者病情更严重，死亡率更高，但在调整了合并症后，死亡率实际上更低。这表明，尽管最近有心肌缺血，内镜检查在临床上仍应安全进行。
