The clinical characteristics of acute myocardial infarction patients with gastrointestinal bleeding in the elderly / 中华老年医学杂志

ABSTRACT

Objective To investigate the clinical characteristics and prognosis of acute myocardial infarction(AMI) patients with gastrointestinal bleeding (GIB) in the elderly.Methods Total 325 elderly patients with AMI were divided into AMI control group (n=304,patients without gastrointestinal bleeding around the period of AMI),GIB-post-AMI (n=14,patients developing gastrointestinal bleeding after AMI) group and AMI-post-GIB (n=7,patients with gastrointestinal bleeding subsequently suffered an AMI) group.The clinical characteristics and combined end points of cardiovascular death and hospitalization for recurrent angina pectoris,non-lethal AMI,heart failure and stroke were analysed.Results (1) Estimated glomerular filtration rate (eGFR) became lower in the patients with GIB-post-MI (61.9+27.3) ml · min-1 · 1.73 m2 compared with AMI control patients (77.3+27.9) ml · min-1 · 1.73 m2,P＜0.05.Multivariate regression analysis revealed that the relative risk from a decreased eGFR for developing gastrointestinal bleeding after AMI in elderly patients was 0.980 (95％CI:0.960-0.999,P＜0.05).(2) There were significantly less patients adopting anti-platelet and anti-coagulant medications in AMI-post-GIB group and less patients applying aspirin in GIB-post-AMI group as compared with AMI control group,respectively (P＜0.05).AMIpost-GIB patients had significantly lower hemoglobin (74 + 14) g/L than GIB-post-AMI patients (111±25) g/L,P＜0.01.More MI-post-GIB patients (6 cases,85.7％) versus GIB-post-AMI patients (4 cases,28.6％)underwent blood transfusion( P＜0.05).There were significantly less patients adopting PCI and thrombolytic therapy in AMI-post-GIB group as compared to AMI control patients (P＜0.01).(3) The combined end points of cardiovascular death and hospitalization for recurrent angina pectoris,non-lethal MI,heart failure and stroke in GIB-post-MI group were significantly higher than in AMI control group[42.9％ (6/14) vs.17.8％ (54/304),P＜0.05].Conclusions Reduced eGFR is an important predictor for elderly AMI patients developing gastrointestinal bleeding which makes it difficult to take anti-platelet and anti-coagulant medication and to receive revascularization treatment,usually with worse prognosis.