Delaying Cardiac Catheterization in Favor of Endoscopy in Non-ST Elevation Myocardial Infarction Patients Is
Hassam Ali1, Pratik Patel2, Jeffery Lowell3
1Department of Gastroenterology, East Carolina University/Brody School of Medicine, Greenville, NC, 27834, USA. alih20@ecu.edu.
Insights
Performing esophagogastroduodenoscopy (EGD) before cardiac catheterization for non-ST-elevation myocardial infarction (NSTEMI) with non-variceal upper gastrointestinal bleeding (NVUGIB) increases hospital stay, costs, and complications. This approach is linked to worse inpatient outcomes.
Area of Science:
- Cardiology
- Gastroenterology
- Health Services Research
Background:
- Non-variceal upper gastrointestinal bleeding (NVUGIB) in patients with non-ST-elevation myocardial infarction (NSTEMI) presents significant morbidity and mortality risks.
- The optimal timing of diagnostic procedures, specifically esophagogastroduodenoscopy (EGD) versus cardiac catheterization, for these patients remains a critical clinical question.
Purpose of the Study:
- To evaluate and compare inpatient outcomes for patients with NSTEMI and NVUGIB who underwent EGD before cardiac catheterization versus those who underwent EGD after cardiac catheterization.
- To identify potential associations between the sequence of these procedures and key clinical outcomes.
Main Methods:
- Utilized the National Readmission Database (2016-2019) to identify hospitalizations with primary NSTEMI and secondary NVUGIB diagnoses.
- Employed 1:1 propensity score matching to create comparable cohorts based on age, gender, cardiac comorbidities, bleeding causes, and severity.
- Compared outcomes between patients undergoing EGD before cardiac catheterization (cases) and those undergoing EGD after cardiac catheterization (controls).
Main Results:
- A total of 796 matched pairs were analyzed.
- The group undergoing EGD before cardiac catheterization experienced a longer median hospital stay (8 vs. 5 days) and higher median hospital charges ($111,218 vs. $99,115).
- This group also showed a higher proportion of ICU admissions (7% vs. 3%), atrial fibrillation (27.1% vs. 19.8%), and acute kidney injury (42.8% vs. 29.1%).
Conclusions:
- Delaying cardiac catheterization in favor of initial EGD in NSTEMI patients with NVUGIB is associated with increased hospital length of stay, higher costs, and a greater incidence of cardiac complications.
- Further research is necessary to confirm these findings and inform clinical guidelines regarding the management of concurrent NSTEMI and NVUGIB.
Background:
Non-variceal upper gastrointestinal bleeding (NVUGIB) in non-ST-elevation myocardial infarction (NSTEMI) is associated with substantial morbidity and mortality. We evaluated inpatient outcomes of esophagogastroduodenoscopy (EGD) before cardiac catheterization in patients with NSTEMI and NVUGIB.
Methods:
We utilized the National Readmission Database (2016-2019) to identify all index hospitalizations with a primary diagnosis of NSTEMI and a secondary diagnosis of NVUGIB that underwent EGD before cardiac catheterization (cases). A matched comparison cohort of similar hospitalizations that undergo EGD after cardiac catheterization were identified (controls) after 1:1 propensity score matching for age, gender, cardiac comorbidities, causes, and severity of bleeding.
Results:
A total of 796 cases were matched with 796 controls. There was a higher median length of hospital stay (8 vs. 5 days, P = 0.01) and median hospital charges ($111,218 vs. $99,115, P = 0.002) for cases compared to controls. There was a higher all-cause inpatient mortality in cases compared to controls (5.5% vs. 3.9%, P = 0.26). Furthermore, there was a higher proportion of patients with ICU admission (7% vs. 3%, P < 0.001), septic shock (7.1% vs. 5.8%, P = 0.41), atrial fibrillation (27.1% vs. 19.8%, P < 0.001) and acute kidney injury (42.8% vs. 29.1%, P < 0.001) for cases compared to controls.
Conclusion:
Delaying cardiac catheterization in favor of EGD is associated with increased hospital stay, costs, and cardiac complications. Further studies are warranted to establish our findings.
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