S3175 Gastrointestinal Bleeding and Endoscopic Evaluation Within 90 Days of Acute Cardiac Event

Abstract

INTRODUCTION: Patients are at increased risk of gastrointestinal bleeding (GIB) after acute coronary syndrome (ACS). The diagnosis and management of GIB in this setting is challenging as the risk of endoscopic intervention and sedation increases after ACS. The risk of sedation increases multifold with increasing ASA status. Re-vascularization of coronary lesions via stenting or CABG should theoretically decrease this risk by restoring blood flow to the ischemic myocardium. Data regarding safety of endoscopic evaluation before and after a myocardial infarction remains sparse in the literature. METHODS: We reviewed the chart of a sample of 119 patients admitted for GIB within 90 days before and after an ACS event between 2008 and 2019. Patients were identified through ICD billing codes for myocardial infarction, angina, and GIB. We collected data on 61 of these patients who met the inclusion criteria for this study. Descriptive statistics was used to tabulate the findings. RESULTS: Our cohort included 41 men (67%) with an average age of 71 +/- 23.2 years. 32 patients (52%) were receiving dual anti-platelet therapy at the time of GIB and 16 (26%) were receiving anticoagulation at the time of bleeding. Majority of these patients, 49 (80%) underwent endoscopic evaluation within 3 months after cardiac event, while 8 patients (13%), underwent endoscopic evaluation within 3 months prior to ACS. A source of bleeding could be identified in 36 (59%) of patients with 16 (26%) exhibiting signs of active bleeding or stigmata of recent bleeding at the time of evaluation. 22 (37%) patients were diagnosed with peptic ulcer disease, while angioectasias were the second most common finding. Rebleeding was observed in 9 (15%) of patients with all but one occurring in the first month after the incident bleed. At least 4 patients did not undergo evaluation for GIB given cardiac arrest, refractory cardiogenic shock and anticipated imminent death. All-cause mortality was 18% at 1 year, however, none of the deaths occurred during or within 24 hrs of endoscopic evaluation and all were attributed to non-GI causes. CONCLUSION: GIB occurs commonly in patients after ACS often in a setting of anti-platelet, anti-coagulant therapy. While endoscopic evaluation is high risk after ACS, it remains safe in most patients following appropriate revascularization. However, mortality in patients with ACS and GIB is high within 1 year of the events, mostly attributed to non-GI etiology.Table 1Table 2