Silent myocardial ischemia in coronary artery disease patients under aspirin therapy presenting with upper gastrointestinal hemorrhage

Chien Chih Chen, Chee Fah Chong, Cheng Deng Kuo, Zong-Lun Wang

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Aim: To identify the risk factors for myocardial ischemia in patients undergoing aspirin therapy for coronary artery disease (CAD) presenting with upper gastrointestinal hemorrhage and to ascertain the impacts on mortality and length of hospital stay. Methods: Adults with CAD under aspirin therapy (100 mg once daily) presenting to the emergency department with upper gastrointestinal hemorrhage were retrospectively recruited and divided into group A (ischemia) and group B (non-ischemia). Charts were reviewed for various demographic, laboratory and outcome data. Electrocardiograms were interpreted blindly by a senior cardiologist. Results: A total of 152 patients, 72.4% men and 27.6% women, were analyzed. Of these, 31 patients had ischemia and were placed in group A and 121 patients did not have ischemia and were in group B. Independent multivariate predictors of myocardial ischemia were history of triple vessel disease (odds ratio [OR], 9.24; 95% confidence interval [CI], 2.00-42.72), lower diastolic blood pressure (OR, 1.09; 95% CI, 1.02-1.16), lower hematocrit (OR, 1.41; 95% CI, 1.16-1.70), and higher blood urea nitrogen (OR, 0.94; 95% CI, 0.89-0.98). Patients with myocardial ischemia had significantly longer hospital length of stay (8.7 ± 4.0 days vs 5.4 ± 1.7 days; P <0.001) and higher in-hospital mortality (16.1% vs 2.5%; P <0.01) than did those without myocardial ischemia. Conclusion: Myocardial ischemia is a relatively common complication in CAD patients under aspirin therapy presenting with upper gastrointestinal hemorrhage. A history of CAD with triple vessel disease, higher blood urea nitrogen, lower diastolic blood pressure and lower hematocrit may help identify patients who are at increased risk of myocardial ischemia, which tends to be associated with higher in-hospital mortality and increased length of hospital stay.

Original languageEnglish
Pages (from-to)13-17
Number of pages5
JournalJournal of Gastroenterology and Hepatology (Australia)
Volume22
Issue number1
DOIs
Publication statusPublished - 2007

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Gastrointestinal Hemorrhage
Aspirin
Myocardial Ischemia
Coronary Artery Disease
Length of Stay
Odds Ratio
Confidence Intervals
Blood Pressure
Ischemia
Blood Urea Nitrogen
Hospital Mortality
Hematocrit
Therapeutics
Hospital Emergency Service
Electrocardiography
Demography
Mortality

Keywords

  • Anemia
  • Aspirin
  • Mortality
  • Myocardial ischemia
  • Upper gastrointestinal hemorrhage

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology

Cite this

Silent myocardial ischemia in coronary artery disease patients under aspirin therapy presenting with upper gastrointestinal hemorrhage. / Chen, Chien Chih; Chong, Chee Fah; Kuo, Cheng Deng; Wang, Zong-Lun.

In: Journal of Gastroenterology and Hepatology (Australia), Vol. 22, No. 1, 2007, p. 13-17.

Research output: Contribution to journalArticle

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abstract = "Aim: To identify the risk factors for myocardial ischemia in patients undergoing aspirin therapy for coronary artery disease (CAD) presenting with upper gastrointestinal hemorrhage and to ascertain the impacts on mortality and length of hospital stay. Methods: Adults with CAD under aspirin therapy (100 mg once daily) presenting to the emergency department with upper gastrointestinal hemorrhage were retrospectively recruited and divided into group A (ischemia) and group B (non-ischemia). Charts were reviewed for various demographic, laboratory and outcome data. Electrocardiograms were interpreted blindly by a senior cardiologist. Results: A total of 152 patients, 72.4{\%} men and 27.6{\%} women, were analyzed. Of these, 31 patients had ischemia and were placed in group A and 121 patients did not have ischemia and were in group B. Independent multivariate predictors of myocardial ischemia were history of triple vessel disease (odds ratio [OR], 9.24; 95{\%} confidence interval [CI], 2.00-42.72), lower diastolic blood pressure (OR, 1.09; 95{\%} CI, 1.02-1.16), lower hematocrit (OR, 1.41; 95{\%} CI, 1.16-1.70), and higher blood urea nitrogen (OR, 0.94; 95{\%} CI, 0.89-0.98). Patients with myocardial ischemia had significantly longer hospital length of stay (8.7 ± 4.0 days vs 5.4 ± 1.7 days; P <0.001) and higher in-hospital mortality (16.1{\%} vs 2.5{\%}; P <0.01) than did those without myocardial ischemia. Conclusion: Myocardial ischemia is a relatively common complication in CAD patients under aspirin therapy presenting with upper gastrointestinal hemorrhage. A history of CAD with triple vessel disease, higher blood urea nitrogen, lower diastolic blood pressure and lower hematocrit may help identify patients who are at increased risk of myocardial ischemia, which tends to be associated with higher in-hospital mortality and increased length of hospital stay.",
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AB - Aim: To identify the risk factors for myocardial ischemia in patients undergoing aspirin therapy for coronary artery disease (CAD) presenting with upper gastrointestinal hemorrhage and to ascertain the impacts on mortality and length of hospital stay. Methods: Adults with CAD under aspirin therapy (100 mg once daily) presenting to the emergency department with upper gastrointestinal hemorrhage were retrospectively recruited and divided into group A (ischemia) and group B (non-ischemia). Charts were reviewed for various demographic, laboratory and outcome data. Electrocardiograms were interpreted blindly by a senior cardiologist. Results: A total of 152 patients, 72.4% men and 27.6% women, were analyzed. Of these, 31 patients had ischemia and were placed in group A and 121 patients did not have ischemia and were in group B. Independent multivariate predictors of myocardial ischemia were history of triple vessel disease (odds ratio [OR], 9.24; 95% confidence interval [CI], 2.00-42.72), lower diastolic blood pressure (OR, 1.09; 95% CI, 1.02-1.16), lower hematocrit (OR, 1.41; 95% CI, 1.16-1.70), and higher blood urea nitrogen (OR, 0.94; 95% CI, 0.89-0.98). Patients with myocardial ischemia had significantly longer hospital length of stay (8.7 ± 4.0 days vs 5.4 ± 1.7 days; P <0.001) and higher in-hospital mortality (16.1% vs 2.5%; P <0.01) than did those without myocardial ischemia. Conclusion: Myocardial ischemia is a relatively common complication in CAD patients under aspirin therapy presenting with upper gastrointestinal hemorrhage. A history of CAD with triple vessel disease, higher blood urea nitrogen, lower diastolic blood pressure and lower hematocrit may help identify patients who are at increased risk of myocardial ischemia, which tends to be associated with higher in-hospital mortality and increased length of hospital stay.

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