Acute Myocardial Infarction Risk in Patients with Coronary Artery Disease Doubled after Upper Gastrointestinal Tract Bleeding: A Nationwide Nested Case-Control Study.

Chia-Jung Wu,Chien-Chin Hsu,How-Ran Guo,Jhi-Joung Wang,Chien-Cheng Huang,Hung-Jung Lin,Shih-Bin Su,Shih-Feng Weng,Carmine Pizzi

doi:10.1371/journal.pone.0142000

Abstract

Prior studies of upper gastrointestinal bleeding (UGIB) and acute myocardial infarction (AMI) are small, and long-term effects of UGIB on AMI have not been delineated. We investigated whether UGIB in patients diagnosed with coronary artery disease (CAD) increased their risk of subsequent AMI. This was a population-based, nested case-control study using Taiwan’s National Health Insurance Research Database. After propensity-score matching for age, gender, comorbidities, CAD date, and follow-up duration, we identified 1,677 new-onset CAD patients with AMI (AMI[+]) between 2001 and 2006 as the case group and 10,062 new-onset CAD patients without (AMI[−]) as the control group. Conditional logistic regression was used to examine the association between UGIB and AMI. Compared with UGIB[−] patients, UGIB[+] patients had twice the risk for subsequent AMI (adjusted odds ratio [AOR] = 2.08; 95% confidence interval [CI], 1.72–2.50). In the subgroup analysis for gender and age, UGIB[+] women (AOR = 2.70; 95% CI, 2.03–3.57) and patients < 65 years old (AOR = 2.23; 95% CI, 1.56–3.18) had higher odds of an AMI. UGIB[+] AMI[+] patients used nonsignificantly less aspirin than did UGIB[−] AMI[+] patients (27.69% vs. 35.61%, respectively). UGIB increased the risk of subsequent AMI in CAD patients, especially in women and patients < 65. This suggests that physicians need to use earlier and more aggressive intervention to detect UGIB and prevent AMI in CAD patients.

Highlights

Upper gastrointestinal bleeding (UGIB) is a common, costly, and potentially life-threatening disease [1]
The adjusted odds ratio (OR) (AOR) for acute myocardial infarction (AMI)[+] patients with UGIB was 2.08
We found that patients with coronary artery disease (CAD) and UGIB, especially women and those < 65 years old, had twice the risk of developing an AMI than did CAD patients without UGIB

Summary

Introduction

Upper gastrointestinal bleeding (UGIB) is a common, costly, and potentially life-threatening disease [1]. It must be managed promptly and appropriately to prevent adverse outcomes [1]. In the U.S, the annual rate of hospitalization for peptic ulcer disease and UGIB is estimated to be 165 per 100,000 in 1999—more than 300,000 hospitalizations per year, at a cost of $2.5 billion [3,4]. Despite advances in therapy, the mortality rate has remained unchanged at 7–10% [6]. This may be because today’s patients are older and have more comorbidities than did patients in the past [7]

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