Clinical Characteristics and Risk Factors of In-Hospital Mortality in Patients With Acute Myocardial Infarction With Subsequent Gastrointestinal Bleeding: A Single-Center Experience

Xin Su; Yuzhen Wei; Shuo Pang; Zeqing Zhang; Yunxiao Zhang; Peipei Zheng; Haiyu Li; Haiqiang Sang; Jianzeng Dong

doi:10.3389/fcvm.2022.942467

Clinical Characteristics and Risk Factors of In-Hospital Mortality in Patients With Acute Myocardial Infarction With Subsequent Gastrointestinal Bleeding: A Single-Center Experience

Front Cardiovasc Med. 2022 Jul 13:9:942467. doi: 10.3389/fcvm.2022.942467. eCollection 2022.

Authors

Xin Su¹, Yuzhen Wei¹, Shuo Pang¹, Zeqing Zhang¹, Yunxiao Zhang¹, Peipei Zheng¹, Haiyu Li¹, Haiqiang Sang¹, Jianzeng Dong^{1

2}

Affiliations

¹ Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
² Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.

Abstract

Objective: 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.

Methods: 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.

Results: 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, P = 0.011), condition of cardiogenic shock after admission (OR 14.52, 95% CI 3.36-62.62, P < 0.001), and the use of the mechanical ventilator (OR 8.14, 95% CI 2.03-32.59, P = 0.003) were significantly associated with in-hospital mortality.

Conclusion: 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.

Keywords: acute myocardial infarction; gastrointestinal bleeding; in-hospital mortality; percutaneous coronary intervention; thrombolysis.