University of South Florida Morsani College of Medicine Tampa, FL, United States
Shreya Narayanan, MD, Brian Black, MD, Ambuj Kumar, MD, Wojciech Blonski, MD, PhD, Pushpak Taunk, MD University of South Florida Morsani College of Medicine, Tampa, FL
Introduction: Timely coronary angiography for diagnosis and therapy with percutaneous coronary intervention (PCI) is the standard of care for the acute management of acute coronary syndromes (ACS), alongside medical therapies including anticoagulant and antiplatelet agents. The management of ACS is confounded in patients presenting with concomitant overt gastrointestinal (GI) bleeding. There remains uncertainty around the timing of left heart catheterization (LHC) in relation to endoscopy. Thus, the objective of this study was to compare safety and outcomes in patients with concomitant ACS and overt GI bleeding who underwent both LHC and endoscopy.
Methods: This was a retrospective cohort study approved by the USF IRB. All consecutive patients diagnosed with concomitant ACS and GI bleeding between 2000-2020 who underwent EGD for evaluation of GI bleeding and LHC for ACS within seven days prior or 10 days after EGD were eligible for inclusion. Data regarding baseline demographics, pertinent comorbidities, and clinical outcomes was collected.
Results: A total of six patients met inclusion criteria. The average age of the patients was 61.2 years. Four male and two female patients were included. One patient (17%) underwent LHC after EGD and five patients (83%) had EGD after LHC. All patients were started on IV proton pump inhibitor for management of bleeding. One patient (17%) was started on heparin alone, one patient was started on an antiplatelet agent alone (17%), and three patients (50%) were treated with both heparin and an antiplatelet agent for medical management of ACS. Endoscopic abnormalities were seen on EGD in five patients (83%), though no therapeutic intervention was required. Culprit lesions were identified in four (66%) patients on LHC. Three patients (50%) were treated with PCI and one patient (17%) required coronary artery bypass surgery. One patient (17%) who had EGD after LHC developed new onset heart failure. No new arrhythmias, recurrent GI bleeding, or death occurred in any of the patients.
Discussion: The results of this study show that EGD is a safe procedure in patients with concomitant ACS and GI bleeding and can be performed either before or after LHC without any significant complications. These results are important to facilitate shared decision making when having to make the choice of performing an EGD before or after LHC. However, the data is limited by small sample size and future larger studies are needed to confirm or refute these findings.
Shreya Narayanan indicated no relevant financial relationships.
Brian Black indicated no relevant financial relationships.
Ambuj Kumar indicated no relevant financial relationships.
Wojciech Blonski indicated no relevant financial relationships.
Pushpak Taunk indicated no relevant financial relationships.
Shreya Narayanan, MD, Brian Black, MD, Ambuj Kumar, MD, Wojciech Blonski, MD, PhD, Pushpak Taunk, MD. P0462 - Safety of Endoscopy in Patients Undergoing Percutaneous Coronary Angiography With Concomitant GI Bleeding and Acute Coronary Syndrome, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.