Myocardial infarction complicating gastrointestinal hemorrhage

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.