Objective: To determine the frequency of and risk factors for myocardial in
farction (MI) in patients admitted to an intensive-care unit (ICU) with gas
trointestinal (GI) hemorrhage and to ascertain the effects on mortality and
lengths of stay.
Material and Methods: Demographic, laboratory, and outcome data were determ
ined for all patients admitted to a medical ICU with GI hemorrhage between
April 1996 and January 1997. Serial creatine kinase with isoenzyme levels a
nd electrocardiograms were interpreted blindly by a senior cardiologist.
Results: For 83 consecutive admissions to the ICU because of GI hemorrhage,
the patients' mean (+/- standard error) age was 65.0 +/- 1.7 years and APA
CHE II (acute physiology and chronic health evaluation) score was 15.7 +/-
0.8. In-hospital death occurred in 16 patients(19%). Patients who did not s
urvive had a lower admission systolic blood pressure (99.2 +/- 4.5 versus 1
15.0 +/- 4.0 mm Hg; P = 0.01) than did those who survived. Eleven of 83 pat
ients (13%) fulfilled both enzymatic and electrocardiographic criteria for
MI. Ten patients (12%) had electrocardiographic evidence of myocardial isch
emia hut did not meet criteria for MI. Patients with MI were older (74.4 +/
- 4.0 versus 61.7 +/- 2.0 years; P<0.05), had a higher acuity of illness (A
PACHE II score, 21.6 +/- 3.0 versus 14.6 +/- 0.7; P<0.05), and had more cor
onary risk factors (2.3 +/- 0.3 versus 1.4 +/- 0.1; P<0.05) in comparison w
ith those without MI or ischemia. Patients with MI also had longer ICU (8.6
+/- 2.4 versus 3.3 +/- 0.4 days; P<0.05) and hospital (16.3 +/- 3.4 versus
9.1 +/- 0.8 days; P<0.05) lengths of stay. Patients older than 65 years ha
d a threefold increased risk (risk ratio, 4.0; 95% confidence interval, 0.9
to 17.4) and those with two or more risk factors for coronary artery disea
se had a ninefold increased risk of MI (risk ratio, 10.2; 95% confidence in
terval, 1.4 to 76.1) in comparison with those who were younger or who had f
ewer coronary risk factors, respectively. MI complicating GI hemorrhage did
not significantly affect the risk of in-hospital mortality (risk ratio, 1.
5; 95% confidence interval, 0.5 to 4.4).
Conclusion: MI occurs frequently in patients with GI hemorrhage admitted to
an ICU. Age more than 65 years and two or more risk factors for coronary a
rtery disease identify patients who are at greatest risk for occurrence of
MI, which is associated with longer ICU and hospital stays.