Su Xin, Wei Yuzhen, Pang Shuo, Zhang Zeqing, Zhang Yunxiao, Zheng Peipei, Li Haiyu, Sang Haiqiang, Dong Jianzeng
Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Front Cardiovasc Med. 2022 Jul 13;9:942467. doi: 10.3389/fcvm.2022.942467. eCollection 2022.
Gastrointestinal 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.
In 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.
Among 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, = 0.011), condition of cardiogenic shock after admission (OR 14.52, 95% CI 3.36-62.62, < 0.001), and the use of the mechanical ventilator (OR 8.14, 95% CI 2.03-32.59, = 0.003) were significantly associated with in-hospital mortality.
Regardless 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.
急性心肌梗死（AMI）后胃肠道出血（GIB）是一种严重的临床病症，预后较差。本研究的目的是评估AMI后发生GIB患者的院内死亡率，并确定这种情况的潜在危险因素。
在这项单中心回顾性研究中，从2013年10月至2021年12月共纳入154例诊断为AMI且随后发生GIB的患者。收集了人口统计学、实验室和临床数据。院内死亡率是感兴趣的结局。采用逻辑回归分析来研究院内死亡的潜在危险因素。
在最终分析纳入的154名受试者中，平均年龄为65.58±11.20岁，男性104例（67.53%）。11例患者在溶栓治疗后发生GIB，50例患者在经皮冠状动脉介入治疗（PCI）后发生GIB，93例患者在药物保守治疗期间发生GIB。共有41例患者在医院死亡。溶栓组、PCI组和药物保守治疗组的院内死亡率分别为27.27%（3/11）、28.00%（14/50）和25.81%（24/93）。三组之间的院内死亡率无差异。多因素逻辑回归分析显示，肌钙蛋白I（TnI）峰值水平（OR 1.07，95%CI 1.02 - 1.12，P = 0.011）、入院后心源性休克情况（OR 14.52，95%CI 3.36 - 62.62，P < 0.001）以及使用机械通气（OR 8.14，95%CI 2.03 - 32.59，P = 0.003）与院内死亡率显著相关。
无论AMI的治疗策略如何，一旦发生GIB，预后都较差。AMI后发生GIB患者的高院内死亡率与TnI峰值水平、心源性休克情况以及使用机械通气独立相关。
