Original Article

Endoscopy After Acute Myocardial Infarction: An Evaluation of Safety

Authors: Roxanne G. Lim, MD, William J. Cobell, MD, Shoba Theivanayagam, MD, Todd W. Kilgore, MD, Michelle L. Matteson, PhD, Srinivas R. Puli, MD, Matthew L. Bechtold, MD, FACG

Abstract

Objectives: Upper gastrointestinal bleeding in the setting of acute myocardial infarction (MI) has substantial morbidity and mortality. Several studies have been performed on the safety of esophagogastroduodenoscopy (EGD) after MI; however, these studies vary in definitions and results. We evaluated the safety and effect of EGD in patients with acute MI in a tertiary center.

Methods: A retrospective, single tertiary-care center study was undertaken of 87 patients who underwent EGD within 30 days of an acute MI between January 2001 and March 2012. Type of MI (ST segment elevation MI [STEMI] and non–ST segment elevation MI [NSTEMI]), peak troponin I, time from MI to EGD, Acute Physiology and Chronic Health Evaluation (APACHE) II score at EGD, cardiac catheterization before EGD, and medical complications within 24 hours of EGD were noted. Medical complications were defined as major complications (death, life-threatening arrhythmias) and minor complications (chest pain, abnormal vital signs, or minor arrhythmias).

Results: Eighty-seven patients underwent EGD within 30 days of having an MI. No major complications were observed. Minor complications occurred in 27 of 87 patients (31.0%), including mild hypotension, mild bradycardia, or increased chest pain. Patients with STEMI demonstrated statistically significant quicker endoscopy (P = 0.01) and were more likely to undergo cardiac catheterization in advance of EGD (P < 0.01) than those with NSTEMI. No statistically significant differences were noted for peak troponin I (P = 0.21), APACHE II score at EGD (P = 0.55), or minor complications (P = 0.08) among patients with STEMI versus NSTEMI. Cardiac catheterization before EGD did not seem to affect results. Patients with APACHE II scores >16 experienced more minor complications (P = 0.02).

Conclusions: EGD appears relatively safe for the diagnosis and management of upper gastrointestinal bleeding in patients with acute MI.

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References

1. Lin S, Konstance R, Jollis J, et al. The utility of upper endoscopy in patients with concomitant upper gastrointestinal bleeding and acute myocardial infarction. Dig Dis Sci. 2006; 51: 2377–2383.
 
2. Yachimski P, Hur C. Upper endoscopy in patients with acute myocardial infarction and upper gastrointestinal bleeding: results of a decision analysis. Dig Dis Sci. 2009; 54: 701–711.
 
3. Sharma VK, Nguyen CC, Crowell MD, et al. A national study of cardiopulmonary unplanned events after GI endoscopy. Gastrointest Endosc. 2007; 66: 27–34.
 
4. Yazawa K, Adachi W, Koide N, et al. Changes in cardiopulmonary parameters during upper gastrointestinal endoscopy in patients with heart disease: towards safer endoscopy. Endoscopy. 2000; 32: 287–293.
 
5. Mori A, Ohashi N, Tatebe H, et al. Autonomic nervous function in upper gastrointestinal endoscopy: a prospective randomized comparison between transnasal and oral procedures. J Gastroenterol. 2008; 43: 38–44.
 
6. Al-Ebrahim F, Khan KJ, Alhazzani W, et al. Safety of esophagogastroduodenoscopy within 30 days of myocardial infarction: a retrospective cohort study from a Canadian tertiary centre. Can J Gastroenterol. 2012; 26: 151–154.
 
7. Mumtaz K, Ismail FW, Jafri W, et al. Safety and utility of oesophagogastroduodenoscopy in acute myocardial infarction. Eur J Gastroenterol Hepatol. 2008; 20: 51–55.
 
8. Cappell MS. Problems with combining together EGD, PEG, flexible sigmoidoscopy, and colonoscopy to analyze risks of endoscopic procedures after MI: a call for stratifying risk according to individual endoscopic procedures. J Clin Gastroenterol. 2009; 43: 98–99.
 
9. Cappell MS. The safety and clinical utility of esophagogastroduodenoscopy for acute gastrointestinal bleeding after myocardial infarction: a six-year study of 42 endoscopies in 34 consecutive patients at two university teaching hospitals. Am J Gastroenterol. 1993; 88: 344–350.
 
10. Cappell MS, Iacovone FM Jr. Safety and efficacy of esophagogastroduodenoscopy after myocardial infarction. Am J Med. 1999; 106: 29–35.
 
11. Knaus WA, Draper EA, Wagner DP, et al. APACHE II: a severity of disease classification system. Crit Care Med. 1985; 13: 818–829.