Abstract
PURPOSE: To analyze the risks versus benefits of esophagogastroduodenoscopy performed
soon after myocardial infarction.
PATIENTS AND METHODS: We studied 200 patients who underwent endoscopy within 30 days
after myocardial infarction with 200 controls matched for age, sex, and endoscopic
indication who underwent endoscopy without a history of myocardial infarction within
the prior 6 months. Odds ratios (OR) and 95% confidence intervals (CI) are reported.
RESULTS: The indications for endoscopy included hematemesis in 88, melena in 43, fecal
occult blood and anemia in 33, red blood per rectum in 13, abdominal pain in 13, and
other indications in 10. Endoscopy was performed a mean (± SD) of 9.1 ± 8.9 days after
myocardial infarction, was diagnostic in 85% of all the patients, and was more frequently
diagnostic when performed for hematemesis or melena than when performed for other
indications (92% vs 71%, P <0.0003). Common diagnoses included duodenal ulcer, gastric ulcer, gastritis, and
esophagitis. Fifteen post–myocardial infarction patients (7.5%) suffered endoscopic
complications, including fatal ventricular tachycardia (n = 1), near respiratory arrest
(n = 1), mild hypotension (n = 11), and moderate hypoxemia (n = 2), compared with
three patients (1.5%) in the control group (OR = 5.3, CI = 1.5 to 19). Patients who
had endoscopic complications after myocardial infarction had a significantly higher
APACHE II score than those who did not (mean score of 17.3 ± 5.8 vs 11.7 ± 5.7, P <0.001). Endoscopic complications occurred in 21% (12 of 58) of post–myocardial infarction
patients who were very ill (APACHE II score ≥16) but in only 2% (3 of 142) of those
whose condition was relatively stable (APACHE II score ≤15, OR = 12; CI = 3.3 to 45).
Hypotension before endoscopy and a high APACHE II score were independent risk factors
for complications in post–myocardial infarction patients.
CONCLUSIONS: Relatively stable patients with upper gastrointestinal bleeding and recent
myocardial infarction can and should undergo esophagogastroduodenoscopy. Most endoscopic
complications in these patients are cardiopulmonary, and they generally occur in very
ill patients.
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Article info
Publication history
Published online: August 16, 2004
Accepted:
August 18,
1998
Received in revised form:
August 18,
1998
Received:
January 9,
1998
Identification
Copyright
© 1999 Excerpta Medica Inc. Published by Elsevier Inc. All rights reserved.
