Abstract
Background
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.
Methods
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.
Results
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).
Conclusion
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.
Keywords
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References
- Influence of bleeding on haemorheology and haemostasis in surgery.Clin Hemorheol Microcirc. 2010; 46: 183-188
- Bleeding events are associated with an increase in markers of inflammation in acute coronary syndromes: an ACUITY trial substudy.J Thromb Thrombolysis. 2011; 31: 139-145
- Clinical outcomes and management associated with major bleeding in patients with atrial fibrillation treated with apixaban or warfarin: insights from the ARISTOTLE trial.Eur Heart J. 2015; 36: 1264-1272
- Acute myocardial infarction risk in patients with coronary artery disease doubled after upper gastrointestinal tract bleeding: a nationwide nested case-control study.PLoS One. 2015; 10e0142000
- 2016 ACC/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines.J Am Coll Cardiol. 2016; 68: 1082-1115
- Defining high bleeding risk in patients undergoing percutaneous coronary intervention: a consensus document from the Academic Research Consortium for High Bleeding Risk.Eur Heart J. 2019; 40: 2632-2653
- Impact of “nuisance” bleeding on clopidogrel compliance in patients undergoing intracoronary drug-eluting stent implantation.Am J Cardiol. 2008; 102: 1614-1617
- Zotarolimus-eluting versus bare-metal stents in uncertain drug-eluting stent candidates.J Am Coll Cardiol. 2015; 65: 805-815
- Polymer-free drug-coated coronary stents in patients at high bleeding risk.N Engl J Med. 2015; 373: 2038-2047
- Sex-based outcomes in patients with a high bleeding risk after percutaneous coronary intervention and 1-month dual antiplatelet therapy: a secondary analysis of the LEADERS FREE randomized clinical trial.JAMA Cardiol. 2020; 5: 939-947
- The healthcare cost and utilization project: an overview.Eff Clin Pract. 2002; 5: 143-151
- Annual risk of major bleeding among persons without cardiovascular disease not receiving antiplatelet therapy.JAMA. 2018; 319: 2507-2520
- Perioperative acute myocardial infarction associated with non-cardiac surgery.Eur Heart J. 2017; 38: 2409-2417
- Comorbidity measures for use with administrative data.Med Care. 1998; 36: 8-27
- perioperative major adverse cardiovascular and cerebrovascular events associated with noncardiac surgery.JAMA Cardiol. 2017; 2: 181-187
- Patient outcomes with endovascular embolectomy therapy for acute ischemic stroke: a study of the national inpatient sample: 2006 to 2008.Stroke. 2011; 42: 1648-1652
- Acute respiratory failure and mechanical ventilation in cardiogenic shock complicating acute myocardial infarction in the USA, 2000-2014.Ann Intensive Care. 2019; 9: 96
- Impact of bleeding on mortality after percutaneous coronary intervention results from a patient-level pooled analysis of the REPLACE-2 (randomized evaluation of PCI linking angiomax to reduced clinical events), ACUITY (acute catheterization and urgent intervention triage strategy), and HORIZONS-AMI (harmonizing outcomes with revascularization and stents in acute myocardial infarction) trials.JACC Cardiovasc Interv. 2011; 4: 654-664
- Readmissions rates after myocardial infarction for gastrointestinal bleeding: a national perspective.Dig Dis Sci. 2021; 66: 751-759
- Gastrointestinal bleeding in patients with acute coronary syndromes: incidence, predictors, and clinical implications: analysis from the ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) trial.J Am Coll Cardiol. 2009; 54: 1293-1302
- Gastrointestinal bleeding in high risk survivors of myocardial infarction: the VALIANT Trial.Eur Heart J. 2009; 30: 2226-2232
- Risks of bleeding recurrence and cardiovascular events with continued aspirin use after lower gastrointestinal hemorrhage.Gastroenterology. 2016; 151: 271-277
- Continuation of low-dose aspirin therapy in peptic ulcer bleeding: a randomized trial.Ann Intern Med. 2010; 152: 1-9
- 2020 ACC Expert Consensus Decision Pathway on Management of Bleeding in Patients on Oral Anticoagulants: A Report of the American College of Cardiology solution set oversight committee.J Am Coll Cardiol. 2020; 76: 594-622
- Association of thrombocytopenia, revascularization, and in-hospital outcomes in patients with acute myocardial infarction.Am J Med. 2019; 132: 942-948.e5
- Ticagrelor plus aspirin for 1 month, followed by ticagrelor monotherapy for 23 months vs aspirin plus clopidogrel or ticagrelor for 12 months, followed by aspirin monotherapy for 12 months after implantation of a drug-eluting stent: a multicentre, open-label, randomised superiority trial.Lancet. 2018; 392: 940-949
- Ticagrelor with or without aspirin in high-risk patients after PCI.N Engl J Med. 2019; 381: 2032-2042
- Effect of 1-month dual antiplatelet therapy followed by clopidogrel vs 12-month dual antiplatelet therapy on cardiovascular and bleeding events in patients receiving PCI: The STOPDAPT-2 randomized clinical trial.JAMA. 2019; 321: 2414-2427
- The risks and benefits of long-term use of proton pump inhibitors: expert review and best practice advice from the American Gastroenterological Association.Gastroenterology. 2017; 152: 706-715
Article Info
Publication History
Published online: April 22, 2022
Footnotes
Funding: NRS is supported, in part, by the National Heart, Lung, and Blood Institute of the National Institutes of Health under Award Number K23HL150315. JSB is funded, in part, by the National Heart and Lung Blood Institute of the National Institute of Health (R01HL139909 and R35HL144993).
Conflicts of Interest: None.
Authorship: All authors had access to the data and a role in writing this manuscript.
Identification
Copyright
Published by Elsevier Inc.
