Reappraisal of Upper Gastrointestinal Bleeding Prevalence in Acute Myocardial Infarct Patients Undergoing Urgent Coronary Angiography

Abstract

Purpose: Acute myocardial infarct (MI) patients have never been targeted as patients at high risk for clinically significant gastrointestinal bleeding (CSGB). Because of the stress attributed to this condition and the related therapeutic procedures, the hemodynamic changes and the intensive use of early combined anticoagulant treatments, we believe that this population is at an increased risk for upper gastrointestinal bleeding. The objective of this study is to evaluate the prevalence of CSGB in acute MI patients undergoing urgent coronary angiography using the criteria currently used in the gastroenterological literature. Methods: Using the archives of the Centre Hospitalier Universitaire de Sherbrooke, a historic cohort of all patients diagnosed with a MI who also underwent a coronary angiography between April 1996 and April 2003 was reviewed (1174 patients). Patients with a concurrent diagnosis of upper gastrointestinal bleeding (79 patients) were then selected and screened for CSGB criteria. Patients undergoing non-urgent (>72 hours after diagnosis) and non-therapeutic intended urgent coronary angiography were excluded. All anticoagulant medication and acid-suppressing drugs were listed in the remaining. Results: Clinically significant gastrointestinal bleeding showed an increasing trend through the years with an prevalence of 4.4% in the latest 2 years. A total of 25 cases of clinically significant gastrointestinal bleeding were identified through the six years reviewed with about half the cases (11 cases) in the latest two years. Of these, 92% received a minimum of 3 anticoagulant drugs and nearly half received 4 or more agents. A glycoprotein IIbIIIa inhibitor was administered in 11 of the 25 patients and clopidogrel was used in an increasing trend since 1999. Interestingly, only a quarter of the patients received acid-suppressing agents before their bleeding. Conclusions: Patients undergoing urgent coronary angiography for an acute MI seem to be at high risk for clinically significant gastrointestinal bleeding. The use of early combined multiple anticoagulant drugs could explane the number of bleeding episodes. These results indicate a possible new indication for gastroprotective therapy. A prospective study evaluating the effect of gastroprotective measures in this population is currently undertaken.