Six-Month Cardiovascular Prognostic Impact of Type 1 and Type 2 Myocardial Infarction in Patients Hospitalized for Gastrointestinal Bleeding

Authors

Gayatri Pemmasani, Department of Medicine, SUNY Upstate Medical University, 750 E Adam St, Syracuse, NY 13202, United States. Electronic address: pemmasag@upstate.edu.
Ashwini Ashwath, Department of Medicine, SUNY Upstate Medical University, 750 E Adam St, Syracuse, NY 13202, United States.
Wilbert S. Aronow, Westchester Medical Center and New York Medical College, Valhalla, NY, United States.
Srikanth Yandrapalli, Division of Cardiology, Warren Alpert School of Medicine at Brown University, Providence, RI, United States.
Jonathan Leighton, Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, AZ, United States.
Savio John, Division of Gastroenterology, SUNY Upstate Medical University, Syracuse, NY, United States.

Author Type(s)

Faculty

Journal Title

European Journal of Internal Medicine

First Page

51

Last Page

57

Document Type

Article

Publication Date

10-1-2023

Department

Medicine

Abstract

BACKGROUND: Patients with gastrointestinal bleeding (GIB) are at an increased risk of cardiovascular events and myocardial infarction (MI). Myocardial supply-demand mismatch results in type 2 MI(T2MI) and atherosclerotic plaque rupture leads to type 1 MI(T1MI). Data comparing the prognostic impact of these MI types in GIB are sparse. METHODS: Patients hospitalized for GIB were identified in the 2019 US Nationwide Readmissions Sample. In this population, we studied the differences in management of T1MI and T2MI, and the association of these MI types with in-hospital mortality and risk for 6-month MI and MI-related mortality. RESULTS: Of 444,475 patients admitted for a GIB, 12,860 (2.9%) had an MI (1.7% T2MI, 1.2% T1MI). Patients with T1MI were more likely to receive coronary angiography and revascularization than patients with T2MI. In-hospital mortality occurred in 2.0% patients, at a significantly higher rate in patients with an MI (7.9% vs 1.8%; P < 0.001), and higher with T1MI (11.9%) than T2MI (5.3%; P < 0.001). Among the survivors, 2.2% patient had an MI within 6 months, at a significantly higher rate in patients with index MI (13.1% vs 2.0%, adjusted OR 4.3 95% CI 3.83-4.90; P < 0.001). Mortality during the subsequent MI occurred in 0.3% of all patients (12% with an MI), at a 6-fold higher rate in patients with index MI (1.7% vs 0.3%; adjusted OR 3.69 95% CI 2.75-4.95; P < 0.001). The elevated risks were associated with both MI types. The risks for 6-month MI and related mortality were similar between T1MI and T2MI (6-month AMI: adjusted OR for T2MI = 1.03, 95% 0.83-1.29; fatal MI: adjusted OR for T2MI = 1.5, 95% CI 0.85-2.7). CONCLUSION: The occurrence of an MI is associated with a substantially elevated risk for subsequent AMI and related mortality in patients hospitalized for a GIB. This future prognostic impact was similar between T1MI and T2MI.

Recommended Citation

Pemmasani, G., Ashwath, A., Aronow, W. S., Yandrapalli, S., Leighton, J., & John, S. (2023). Six-Month Cardiovascular Prognostic Impact of Type 1 and Type 2 Myocardial Infarction in Patients Hospitalized for Gastrointestinal Bleeding. European Journal of Internal Medicine, 116, 51-57. https://doi.org/10.1016/j.ejim.2023.07.015