Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Conn.
Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, NY; Department of Surgery, New York University School of Medicine, New York, NY.
Am J Med. 2022 Aug;135(8):e263-e278. doi: 10.1016/j.amjmed.2022.03.030. Epub 2022 Apr 22.
Clinical characteristics of patients with acute myocardial infarction after gastrointestinal bleeding are poorly characterized. We sought to evaluate the incidence, management and outcomes of myocardial infarction following hospitalization for gastrointestinal bleeding.
Patients admitted with a diagnosis of gastrointestinal bleeding with and without subsequent hospital readmissions for acute myocardial infarction within 90 days were identified in the 2014 U.S. Nationwide Readmission Database. Patients with myocardial infarction with and without a recent prior gastrointestinal bleed were compared to determine differences in management and in-hospital outcomes. Logistic regression models were used to estimate odds of invasive management and all-cause in-hospital mortality after covariate adjustment.
A total of 644,622 patients with gastrointestinal bleeding were identified, of which 7523 (1.2%) were readmitted for myocardial infarction within 90 days. Compared to patients with myocardial infarction without recent gastrointestinal bleeding, patients with myocardial infarction within 90 days after gastrointestinal bleeding were older, more likely to be women, have kidney disease, presented with non-ST segment elevation myocarsdial infarction, and were less likely to undergo invasive management of acute myocardial infarction (28% vs 63%, P < .01). Prior gastrointestinal bleeding was associated with higher all-cause in-hospital myocardial infarction mortality (22% vs 9%, P < .01).
In the first 3 months after hospitalization for gastrointestinal bleeding, 1 of every 83 patients was readmitted with acute myocardial infarction. Patients with myocardial infarction after gastrointestinal bleeding were less likely to undergo invasive management and coronary revascularization and had higher mortality than those without recent bleeding.
患有胃肠道出血后急性心肌梗死的患者的临床特征尚未得到很好的描述。我们旨在评估胃肠道出血住院后发生心肌梗死的发生率、处理方法和结局。
在美国 2014 年全国再入院数据库中，确定了因胃肠道出血住院且在 90 天内因急性心肌梗死再次住院的患者（有和无）。比较了因心肌梗死再次住院且近期无胃肠道出血的患者和无近期胃肠道出血的心肌梗死患者，以确定处理方法和院内结局的差异。使用逻辑回归模型在调整协变量后估计有创性管理和全因院内死亡率的可能性。
共确定了 644622 例胃肠道出血患者，其中 7523 例（1.2%）在 90 天内因心肌梗死再次住院。与近期无胃肠道出血的心肌梗死患者相比，90 天内胃肠道出血后发生心肌梗死的患者年龄更大，女性更多，患有肾病，表现为非 ST 段抬高型心肌梗死，接受急性心肌梗死有创性管理的可能性更小（28%对 63%，P <.01）。近期胃肠道出血与全因院内心肌梗死死亡率升高相关（22%对 9%，P <.01）。
在胃肠道出血住院后 3 个月内，每 83 例患者中就有 1 例再次因急性心肌梗死住院。与近期无出血的心肌梗死患者相比，胃肠道出血后发生心肌梗死的患者更不可能接受有创性治疗和冠状动脉血运重建，死亡率更高。
