MYOCARDIAL-INFARCTION IN CRITICALLY ILL PATIENTS PRESENTING WITH GASTROINTESTINAL HEMORRHAGE - RETROSPECTIVE ANALYSIS OF RISKS AND OUTCOMES

Objectives: To determine the frequency of and risk factors for myocard ial infarction (MI) in patients admitted to an ICU with GI hemorrhage, and the effects of MI on mortality and length of stay. Methods: A ret rospective review of the medical records of patients admitted to our I CU with GI hemorrhage was conducted. Charts were reviewed for various demographic, laboratory, and outcome parameters. Patients were categor ized as having MII not having MI, or inadequate data to allow classifi cation. Results: Two hundred thirty admissions to the ICU for GI hemor rhage were reviewed. One hundred thirteen cases had serial creatine ph osphokinase (CK) measurements with isoenzymes allowing diagnosis of MI . In these 113 cases, patients' mean age was 67.4 +/- 1.3 years and th e mean APACHE II (acute physiology and chronic health evaluation) scor e was 10.9 +/- 0.6. The in-hospital mortality rate was 13/113 (11.5%). Patients who did not survive had a higher admission APACHE II score ( 15.8 +/- 2.0 vs 10.2 +/- 0.5; p = 0.02), lower initial systolic BP (10 4.5 +/- 4.4 vs 121.2 +/- 3.2 mm Hg; p = 0.005), and a longer length of ICU stay (8.3 +/- 1.8 vs 4.0 +/- 0.4 days; p = 0.04) than those who s urvived. Sixteen of 113 patients met enzymatic and ECG criteria for MI . One patient complained of chest pain and nine of 16 had shortness of breath and/or dizziness. Patients with MI had significantly more card iac risk factors (2.4 +/- 0.2 vs 1.6 +/- 0.1; p = 0.006), lower presen ting hematocrit (26.0 +/- 1.3 vs 30.5 +/- 0.8; p = 0.007), and lower l owest hematocrit in the first 48 h (22.3 +/- 0.9 vs 25.1 +/- 0.6; p = 0.01), and tended to have a longer ICU stays (7.9 +/- 2.2 vs 4.0 +/- 0 .4 days; p = 0.09) than those without MI. Patients who had MI were not more likely to die during hospitalization (risk ratio = 1.8; 95% conf idence interval, 0.6 to 5.8). Conclusions: Myocardial infarction occur s frequently in patients admitted to intensive care with GI hemorrhage . A clinical history of and multiple risk factors for coronary artery disease may help identify patients who are at increased risk of MP, wh ich tends to be associated with a higher acuity of illness and in-hosp ital mortality. Prospective studies are required to further substantia te these associations.