Department of Medicine, SUNY Upstate Medical University, 750 E Adam St, Syracuse, NY 13202, United States.
Department of Medicine, SUNY Upstate Medical University, 750 E Adam St, Syracuse, NY 13202, United States.
Eur J Intern Med. 2023 Oct;116:51-57. doi: 10.1016/j.ejim.2023.07.015. Epub 2023 Jul 26.
Patients with gastrointestinal bleeding (GIB) are at an increased risk of cardiovascular events and myocardial infarction (MI). Myocardial supply-demand mismatch results in type 2 MI(T2MI) and atherosclerotic plaque rupture leads to type 1 MI(T1MI). Data comparing the prognostic impact of these MI types in GIB are sparse.
Patients hospitalized for GIB were identified in the 2019 US Nationwide Readmissions Sample. In this population, we studied the differences in management of T1MI and T2MI, and the association of these MI types with in-hospital mortality and risk for 6-month MI and MI-related mortality.
Of 444,475 patients admitted for a GIB, 12,860 (2.9%) had an MI (1.7% T2MI, 1.2% T1MI). Patients with T1MI were more likely to receive coronary angiography and revascularization than patients with T2MI. In-hospital mortality occurred in 2.0% patients, at a significantly higher rate in patients with an MI (7.9% vs 1.8%; P < 0.001), and higher with T1MI (11.9%) than T2MI (5.3%; P < 0.001). Among the survivors, 2.2% patient had an MI within 6 months, at a significantly higher rate in patients with index MI (13.1% vs 2.0%, adjusted OR 4.3 95% CI 3.83-4.90; P < 0.001). Mortality during the subsequent MI occurred in 0.3% of all patients (12% with an MI), at a 6-fold higher rate in patients with index MI (1.7% vs 0.3%; adjusted OR 3.69 95% CI 2.75-4.95; P < 0.001). The elevated risks were associated with both MI types. The risks for 6-month MI and related mortality were similar between T1MI and T2MI (6-month AMI: adjusted OR for T2MI = 1.03, 95% 0.83-1.29; fatal MI: adjusted OR for T2MI = 1.5, 95% CI 0.85-2.7).
The occurrence of an MI is associated with a substantially elevated risk for subsequent AMI and related mortality in patients hospitalized for a GIB. This future prognostic impact was similar between T1MI and T2MI.
胃肠道出血 (GIB) 患者发生心血管事件和心肌梗死 (MI) 的风险增加。心肌供需不匹配导致 2 型 MI(T2MI)，动脉粥样硬化斑块破裂导致 1 型 MI(T1MI)。比较这些 MI 类型在 GIB 中的预后影响的数据很少。
在美国 2019 年全国再入院样本中确定因 GIB 住院的患者。在该人群中，我们研究了 T1MI 和 T2MI 的管理差异，以及这些 MI 类型与住院死亡率以及 6 个月 MI 和 MI 相关死亡率风险的关系。
在因 GIB 住院的 444475 名患者中，有 12860 名（2.9%）发生了 MI（1.7% T2MI，1.2% T1MI）。与 T2MI 患者相比，T1MI 患者更有可能接受冠状动脉造影和血运重建。住院死亡率为 2.0%，MI 患者的死亡率明显更高（7.9% vs 1.8%；P<0.001），且 T1MI 患者（11.9%）高于 T2MI 患者（5.3%；P<0.001）。在幸存者中，2.2%的患者在 6 个月内发生 MI，指数 MI 患者的发生率明显更高（13.1% vs 2.0%，调整后的 OR 4.3，95%CI 3.83-4.90；P<0.001）。所有患者中有 0.3%（MI 患者中有 12%）在随后的 MI 期间死亡，指数 MI 患者的死亡率高出 6 倍（1.7% vs 0.3%；调整后的 OR 3.69，95%CI 2.75-4.95；P<0.001）。这些风险与两种 MI 类型均相关。6 个月时 MI 和相关死亡率的风险在 T1MI 和 T2MI 之间相似（6 个月时 AMI：T2MI 的调整后 OR=1.03，95%CI 0.83-1.29；致命性 MI：T2MI 的调整后 OR=1.5，95%CI 0.85-2.7）。
在因 GIB 住院的患者中，MI 的发生与随后发生 AMI 和相关死亡率的风险显著增加相关。这种未来的预后影响在 T1MI 和 T2MI 之间相似。
