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Prospective study of cardiac troponin I release in patients with upper gastrointestinal bleeding
David M Iser1, Alexander J V Thompson, Koon Ket Sia
1Department of Medicine, The University of Melbourne, Western Hospital, Melbourne, Victoria, Australia. david.iser@svhm.org.au
Insights
Acute upper gastrointestinal bleeding carries a significant risk of cardiac injury, with up to 19% of patients experiencing troponin release. This cardiac damage screening is crucial, particularly for elderly patients with hemodynamic instability.
Area of Science:
- Cardiology
- Gastroenterology
- Internal Medicine
Background:
- The incidence of cardiac injury in patients with upper gastrointestinal hemorrhage is not well-established.
- Acute upper gastrointestinal bleeding (UGIB) can precipitate cardiac events.
Purpose of the Study:
- To prospectively assess the risk of cardiac troponin I release in patients with acute UGIB.
- To identify adverse cardiac events associated with UGIB.
Main Methods:
- Prospective study of 156 patients with hematemesis or melena.
- Serial cardiac troponin I assays at 0, 12, and 24 hours.
- Monitoring of creatine kinase levels, electrocardiograms, and clinical data.
Main Results:
- 19% of patients (30/156) showed elevated troponin levels (>0.5 microg/L) within 24 hours.
- Factors associated with troponin release included age >65, hemodynamic instability, history of cardiac disease, post-endoscopy compromise, and re-bleeding.
- 81% of patients had normal troponin levels.
Conclusions:
- Upper gastrointestinal bleeding is linked to a cardiac injury risk of up to 19%.
- Cardiac troponin assays can effectively screen for cardiac damage in UGIB patients.
- Screening is particularly important for elderly patients presenting with hemodynamic instability.
Background And Aim:
The rate of cardiac injury in upper gastrointestinal hemorrhage is unclear. The aims of this study were to determine prospectively the risk of cardiac troponin I release and associated adverse cardiac events in patients with acute upper gastrointestinal hemorrhage.
Methods:
From January to September 2003, we prospectively studied patients with documented hematemesis and melena referred to the gastroenterology unit in a tertiary teaching hospital in Melbourne, Australia. Serial assays for cardiac troponin I were performed at 0, 12 and 24 h. Serial creatine kinase levels and electrocardiographs were also performed. Clinical and biochemical data were collected. The primary endpoint was a troponin level >0.5 microg/L within 24 h of recruitment. Various clinical variables were then compared between the groups of patients with or without troponin rise.
Results:
A total of 156 patients were included in the study. The mean age was 67 years (range 19-96). There were 104 (67%) male patients. A troponin level of greater than 0.5 microg/L was found in 30/156 (19%); 126 (81%) patients had normal troponin levels. Age greater than 65 years, signs of hemodynamic instability at presentation, a recent history of cardiac disease, cardiovascular compromise following endoscopy, and re-bleeding were associated with troponin release.
Conclusion:
Upper gastrointestinal bleeding is associated with a risk of cardiac injury of up to 19%. Troponin assay could be used to screen for cardiac damage, especially in elderly patients who present with hemodynamic instability.
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