Endoscopy safe for hospitalized patients with acute myocardial infarction

Patients hospitalized with acute myocardial infarction appear to have higher mortality rates following endoscopy compared to those who do not undergo the procedure, but mortality turns out to be lower after adjusting for comorbidities, a recent study has shown.

“This suggests that endoscopy is safe and should be performed when clinically indicated despite recent cardiac ischaemia,” the authors said.

In 2016, the number of patients admitted for acute coronary syndrome totalled 1,281,749, of which 55,035 required oesophagogastroduodenoscopy or colonoscopy.

Multivariable regression analysis revealed a lower in-hospital mortality among patients who underwent a gastrointestinal procedure (odds ratio [OR], 0.80; p<0.002) and angiogram (OR, 0.48; p<0.001) after adjusting for age, sex, race, hospital type, need for angiogram and Elixhauser index.

Endoscopy postcatheterization, compared with preangiogram, did not correlate with a difference in mortality (OR, 0.84, 95 percent confidence interval, 0.60–1.19).

This retrospective cohort analysis included all adult inpatients in the National Inpatient Sample (NIS) database from 2016 admitted for ST-elevation myocardial infarction (STEMI), non-STEMI or type II non-STEMI. Data on patient demographics and indication for endoscopy per ICD-10 coding were obtained. HCUPnet was used to query NIS to acquire all inpatient mortality.

The following methods were applied by the authors: adjusted χ² for categorical outcomes, adjusted linear regression for continuous outcomes and adjusted logistic regression for multivariable analysis.

“Patients hospitalized with myocardial infarction are at risk of gastrointestinal bleeding because of the need for antiplatelet agents and/or anticoagulation,” the authors noted.