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Safety and efficacy of esophagogastroduodenoscopy after myocardial infarction1

  • Mitchell S. Cappell
    Correspondence
    Requests for reprints should be addressed to Mitchell S. Cappell, MD, PhD, Division of Gastroenterology, Administration Building, 4th Floor, Maimonides Medical Center, 4802 Tenth Avenue, Brooklyn, New York 11219
    Affiliations
    Division of Gastroenterology, Department of Medicine, Maimonides Medical Center, Brooklyn, New York, USA

    Department of Medicine (MSC), State University of New York Health Science Center at Brooklyn, Brooklyn, New York, USA

    Division of Cardiology (FMI), Department of Medicine, New York Hospital-Cornell Medical Center, Cornell University Medical College, New York, New York, USA
    Search for articles by this author
  • Frank M. Iacovone Jr.
    Affiliations
    Division of Gastroenterology, Department of Medicine, Maimonides Medical Center, Brooklyn, New York, USA

    Department of Medicine (MSC), State University of New York Health Science Center at Brooklyn, Brooklyn, New York, USA

    Division of Cardiology (FMI), Department of Medicine, New York Hospital-Cornell Medical Center, Cornell University Medical College, New York, New York, USA
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      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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