Endoscopy Safe Early After Heart Attack

By Marilynn Larkin

March 06, 2020

NEW YORK (Reuters Health) - Patients hospitalized after a heart attack can safely undergo endoscopy, a large retrospective study reveals.

"Overall, these data indicate that endoscopy is safe after myocardial infarction and should be performed when clinically indicated despite recent cardiac ischemia, and is associated with lower overall mortality after adjustment for comorbidities," Dr. Daniel Stein of Beth Israel Deaconess Medical Center in Boston told Reuters Health by email.

"Generally, a patient with bleeding or concerning anemia should undergo appropriate endoscopic workup regardless of specific factors," he said. "Age is correlated with worse outcomes, but this is true for hospitalization outcomes in general, and age alone should not alone be considered a contraindication."

"For patients with mild anemia, a delayed outpatient procedure can be considered," he added. "The data did show that, if possible, waiting for 72 hours after an angiogram is ideal if the patient is stable."

Dr. Stein and colleagues analyzed data for more than 1 million patients (mean age, 69; 43% women) hospitalized with acute myocardial infarction in 2016. Most (58.9%) were admitted for non-ST-elevation myocardial infarction (NSTEMI), followed by ischemia (32.5%) and STEMI (8.7%).

As reported in the American Journal of Gastroenterology, 55,035 (4.3%) underwent endoscopy. After adjustment for age, Elixhauser index, need for angiogram, sex, race, and hospital type, those who underwent a gastrointestinal procedure (odds ratio, 0.80) and angiogram (OR, 0.48) had lower in-hospital mortality.

Postcatheterization endoscopy was not associated with a difference in mortality compared with preangiogram (OR, 0.84). Findings were similar when restricted to those who underwent stent placement (OR, 1.02).

Further, no difference was seen in the indications for endoscopy for GI bleeding based on timing - i.e., catheterization (32.2%) or endoscopy (36.0%) first.

The authors state, "Patients who underwent endoscopy are sicker and have higher mortality rates than those who do not undergo endoscopy, but after adjusting for comorbidities, mortality is actually lower."

Dr. Stephen J. Heller, Director of Gastrointestinal Endoscopy at Temple University Hospital in Philadelphia, commented, "The main strength of this research is in the vast number of patients included in the study. The principal weakness is that the results of this retrospective study cannot be easily applied to specific clinical scenarios."

"In particular," he said by email, "clinicians should still be wary about performing endoscopy in patients with ongoing untreated chest pain, or serious complications of heart attacks such as uncontrolled congestive heart failure or heart arrhythmia. These patients are still at high risk for complications from the procedures and associated anesthesia."

"The care of these patients should be individualized and requires input and communication among gastroenterologists, cardiologists and anesthesiologists," he concluded.

SOURCE: https://bit.ly/39p9v4f American Journal of Gastroenterology, online February 4, 2020.

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