scholarly journals Risk Factors for Acute Coronary Syndrome in Upper Gastrointestinal Bleeding Patients

2021 ◽  
Vol 2021 ◽  
pp. 1-12
Author(s):  
Tianyu Chi ◽  
Quchuan Zhao ◽  
Peili Wang
Keyword(s):  
Risk Factors ◽  
Coronary Heart Disease ◽  
Acute Coronary Syndrome ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Heart Disease ◽  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Coronary Syndrome ◽  
Upper Gastrointestinal

Background. Upper gastrointestinal bleeding (UGIB) is a common critical disease with a certain fatality rate. Acute coronary syndrome (ACS), another critical ill condition, is a regular occurrence in the UGIB. We identified risk factors for ACS in UGIB. Methods. 676 patients diagnosed with UGIB were enrolled retrospectively. We assessed the occurrence of ACS in UGIB patients and identified the risk factors for ACS by logistic regression analysis and random forest analysis. Results. After propensity score matching (PSM), the ACS group ( n = 69 ) and non-ACS group ( n = 276 ) were analyzed. Logistic regression analysis showed that syncope ( P = 0.001 ), coronary heart disease history ( P = 0.001 ), Glasgow Blatchford score ( P ≤ 0.001 ), Rockall risk score ( P = 0.004 ), red blood cell distribution width (RDW) ( P ≤ 0.001 ), total bilirubin (TBil) ( P = 0.046 ), fibrinogen ( P ≤ 0.001 ), and hemoglobin ( P = 0.001 ) had important roles in ACS patients. With Mean Decrease Gini (MDG) sequencing, fibrinogen, RDW, and hemoglobin were ranked the top three risk factors associated with ACS. In ROC analysis, fibrinogen ( AUC = 0.841 , 95% CI: 0.779-0.903) and RDW ( AUC = 0.826 , 95% CI: 0.769-0.883) obtained good discrimination performance. According to sensitivity > 80 %, the pAUC of fibrinogen and RDW were 0.077 and 0.101, respectively, and there was no significant difference ( P = 0.326 ). However, according to specificity > 80 %, the pAUC of fibrinogen was higher than that of RDW (0.126 vs. 0.088, P = 0.018 ). Conclusion. Fibrinogen and RDW were important risk factors for ACS in UGIB. Additionally, combination with coronary heart disease, syncope, hemoglobin, and TBil played important roles in the occurrence of ACS. Meanwhile, it was also noted that Rockall score and Glasgow Blatchford score should be performed to predict the risk.

scholarly journals Bleeding from the upper gastrointestinal tract in patients with acute coronary pathology receiving dual antiplatelet therapy

2021 ◽  
Vol 20 (Supplement_1) ◽  
Author(s):  
A Sapozhnikov ◽  
V Razin ◽  
O Mazurova ◽  
A Mikaelyan
Keyword(s):  
Risk Factors ◽  
Gastrointestinal Tract ◽  
Gastrointestinal Bleeding ◽  
Unstable Angina ◽  
Antiplatelet Therapy ◽  
Dual Antiplatelet Therapy ◽  
Upper Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Tract ◽  
Coronary Syndrome ◽  
Upper Gastrointestinal

Abstract Funding Acknowledgements Type of funding sources: None. Main funding source(s): own funds Routine administration of dual antiplatelet therapy reduces the incidence of thrombotic complications and deaths in patients with acute coronary syndrome. However, the widespread use of antithrombotic therapy in these patients is associated with a significant risk of bleeding from the upper gastrointestinal tract. Their frequency in patients with AMI according to various data ranges from 1.1% to 2.3%. Purpose of the study. To determine the risk factors for upper gastrointestinal bleeding and its outcome in patients with acute coronary pathology receiving dual antiplatelet therapy. Methods. Analyzed 2632 patients with acute myocardial infarction and 2114 patients with unstable angina who were admitted for a 10-year period (2011-2020) and underwent emergency coronary angiography. The average age of patients is 57 ± 9 years, women – 1649 (35%), men – 3097 (65%). All patients received dual antiplatelet therapy (acetylsalicylic acid and P2Y12 inhibitor). Studies of the state of the gastric mucosa and duodenum were carried out by endoscopic method, which revealed 31 cases of bleeding. Various baseline characteristics and risk factors for upper gastrointestinal bleeding were evaluated. Results. The source of bleeding was: gastric ulcer - 8 cases (26%), duodenal ulcer - 6 (20%), simultaneously 2 or more ulcers - 4 (14%), multiple acute erosions - 8 (26%), single acute erosions of the antral part of the stomach - 2 (7%), Mallory-Weiss syndrome - 2 (7%) and bleeding from varicose veins of the esophagus - 1 (3%). Clinically, patients noted pronounced weakness, dizziness, coffee ground vomitus was observed in 8 (26%) patients, melena in 14 (45 %) patients. Bleeding from the upper gastrointestinal tract was detected in 20 patients with AMI (1% of all AMI) and is characterized by a high frequency of deaths (9; 45%). Fatal cases are mainly associated with the appearance of several ulcers of different localization (multiple acute erosions of the stomach and duodenum). In patients with unstable angina, the frequency of bleeding from the upper GIT is about 0.5%, while the duration of hospitalization is extended by an average of 8 days. Predictors of bleeding from the GIT in patients with acute coronary pathology include the presence of peptic ulcer disease in the anamnesis, elderly (senile) age, previous long-term use of antiplatelet agents (anticoagulants). Conclusion Bleedings from the upper GIT are a serious clinical problem in patients with acute coronary pathology. They are characterized by a long stay in the hospital and a high mortality rate.

scholarly journals Acute Coronary Syndrome in an Intensive Care Unit of a Tertiary Referral Centre in Central Nepal: The Spectrum and Coronary Risk Factors.

2013 ◽  
Vol 52 (190) ◽  
Author(s):  
Mani Prasad Gautam ◽  
Guruprasad Sogunuru ◽  
Gangapatnam Subramanyam ◽  
Lekhjung Thapa ◽  
Raju Paudel ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Intensive Care Unit ◽  
Coronary Heart Disease ◽  
Acute Coronary Syndrome ◽  
Intensive Care ◽  
Heart Disease ◽  
St Elevation Myocardial Infarction ◽  
Coronary Syndrome ◽  
St Elevation

Introduction: Acute coronary syndrome is the major leading cause for coronary care unit admission. Its spectrum comprises a variety of disorders including unstable angina, non ST elevation and ST elevation myocardial infarction.Methods: An observational study was designed to study the spectrum of acute coronary syndrome and associated coronary heart disease risk factors in subjects admitted in intensive care unit from August 2009 to September 2010. Details including coronary risk factors and the categories and outcomes of acute coronary syndrome were analyzed.Results: A total of 57 subjects were included in the study. The majority (63.1%) were males. The mean age was 64.54±13.8 years.  Five (8.8%) patients were ≤45 years and 29 (50.88%) patients were ≥65 years. Majority of the patients were smokers (50.87%). The other major coronary heart disease risk factors were diabetes (43.85%), hypertension (36.87%), dyslipidemia (26.32%) and previous history of coronary heart disease (31.58%). Coronary heart disease figured prominently in the family history as well (26.32%). ST elevation myocardial infarction was the major category (42.11%) followed by non-ST elevation myocardial infarction and unstable angina (31.58% and 26.32% respectively). Myocardial infarction complicated with cardiogenic shock had very high mortality (83.33%).  Conclusions: The ST elevation myocardial infarction was the major clinical form of acute coronary syndrome admitted in intensive care unit. Prevention should be targeted on modifiable risk factors such as the management of risk factors. In addition, the improvement in cardiology service with the establishment of CCU and cathlab might alter the mortality and morbidity in ACS management.Keywords: acute coronary syndrome; coronary risk factors; intensive care unit.

scholarly journals Risk factors for coronary heart disease and the development of acute coronary syndrome in patients with normal lipid metabolism

2016 ◽  
Vol 0 (2(64)) ◽  
pp. 95-98
Author(s):  
Л. В. Хіміон ◽  
О. Б. Ященко ◽  
В. В. Ватага ◽  
О. Г. Дубчак
Keyword(s):  
Risk Factors ◽  
Coronary Heart Disease ◽  
Acute Coronary Syndrome ◽  
Heart Disease ◽  
Lipid Metabolism ◽  
Coronary Syndrome
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