Recent myocardial ischemia in patients presented with upper gastrointestinal bleeding with and without portal hypertension

Abstract

ObjectiveTo assess the relationship between upper gastrointestinal bleeding (UGIB) in both cirrhotic and noncirrhotic groups and the development of acute myocardial infarction (AMI).BackgroundUGIB can cause myocardial ischemia and necrosis. Both UGIB and liver cirrhosis have a higher mortality with the development of AMI, than either of them alone.Patients and methodsA cross-sectional comparative study was done on 263 patients who presented with UGIB, and they were divided into four groups: GI (n = 118), cirrhotic patients; GII (n = 85), noncirrhotic patients; GIII (n = 30), cirrhotic patients with no history of UGIB; and GIV (n = 30), the control group. They were all subjected to history taking, examination, and investigations.ResultsAge was higher in GI than GII (P = 0.0001). Cardiac troponin I (cTn-I) was positive for MI in 18/118 (15.3%) in GI, 20/85 (23.5%) in GII, and 0% in GIII and GIV (P = 0.001). Mortality rate was 11/118 (9.3%) in GI and 4/85 (4.7%) in GII and 0% in GIII and GIV (P = 0.0001). Length of hospital stay (LOS) was higher in GI than GII. There was a positive correlation between Glasgow-Blatchford score and cTn-I elevation (R=+0.19, P = 0.003) (P = 0.0001). Odds ratio of smoking, viral hepatitis, and LOS in cTn-I-positive patients was 12.61, 14.49, and 2.76 times higher than troponin-negative patients, respectively (P = 0.0001).ConclusionPatients with cirrhosis when developing UGIB may be predisposed to AMI especially older ages, men, comorbid diseases, patients with increased LOS;in addition to more complications and higher mortality rate than non-cirrhotic patients.