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Delaying Cardiac Catheterization in Favor of Endoscopy in Non-ST Elevation Myocardial Infarction Patients Is Associated with Worse Outcomes: A Nationwide Analysis

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A Correction to this article was published on 02 November 2023

An Invited Commentary to this article was published on 25 August 2023

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Abstract

Background

Non-variceal upper gastrointestinal bleeding (NVUGIB) in non-ST-elevation myocardial infarction (NSTEMI) is associated with substantial morbidity and mortality. We evaluated inpatient outcomes of esophagogastroduodenoscopy (EGD) before cardiac catheterization in patients with NSTEMI and NVUGIB.

Methods

We utilized the National Readmission Database (2016–2019) to identify all index hospitalizations with a primary diagnosis of NSTEMI and a secondary diagnosis of NVUGIB that underwent EGD before cardiac catheterization (cases). A matched comparison cohort of similar hospitalizations that undergo EGD after cardiac catheterization were identified (controls) after 1:1 propensity score matching for age, gender, cardiac comorbidities, causes, and severity of bleeding.

Results

A total of 796 cases were matched with 796 controls. There was a higher median length of hospital stay (8 vs. 5 days, P = 0.01) and median hospital charges ($111,218 vs. $99,115, P = 0.002) for cases compared to controls. There was a higher all-cause inpatient mortality in cases compared to controls (5.5% vs. 3.9%, P = 0.26). Furthermore, there was a higher proportion of patients with ICU admission (7% vs. 3%, P < 0.001), septic shock (7.1% vs. 5.8%, P = 0.41), atrial fibrillation (27.1% vs. 19.8%, P < 0.001) and acute kidney injury (42.8% vs. 29.1%, P < 0.001) for cases compared to controls.

Conclusion

Delaying cardiac catheterization in favor of EGD is associated with increased hospital stay, costs, and cardiac complications. Further studies are warranted to establish our findings.

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Abbreviations

NVUGIB:

Non-variceal upper gastrointestinal bleeding

NSTEMI:

Non-ST elevation myocardial infarction

EGD:

Esophagogastroduodenoscopy

NRD:

National Readmission Database

NIS:

National inpatient sample

ACS:

Acute coronary syndrome

STEMI:

ST elevation myocardial infarction

PCI:

Percutaneous coronary intervention

PUD:

Peptic ulcer disease

UGIB:

Upper GI bleed

ASGE:

American Society of Gastroenterology

US:

United States

HCUP:

Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project

ICD:

International Classification of Diseases

STATA:

Statistical software for data science

IQR:

Interquartile range

CI:

95% Confidence interval

ICU:

Intensive care unit

AKI:

Acute kidney injury

OR:

Odds ratio

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Funding

The authors report no external funding.

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Authors and Affiliations

  1. Department of Gastroenterology, East Carolina University/Brody School of Medicine, Greenville, NC, 27834, USA

    Hassam Ali, Shiva Poola & William Leland

  2. Department of Gastroenterology, Mather Hospital/Hofstra University Zucker School of Medicine, Port Jefferson, NY, 11777, USA

    Pratik Patel

  3. Department of Internal Medicine, Mather Hospital/Hofstra University Zucker School of Medicine, Port Jefferson, NY, 11777, USA

    Jeffery Lowell

  4. Department of Internal Medicine, Central Michigan College of Medicine, Saginaw, MI, 48601, USA

    Dushyant Singh Dahiya

  5. Department of Internal Medicine, East Carolina University/Brody School of Medicine, Greenville, NC, 27834, USA

    Sukhvir Singh & Ahmed Sami Hammami

  6. Center for Advanced Therapeutic Endoscopy, Porter Adventist Hospital, Centura Health, Denver, CO, USA

    Douglas G. Adler

  7. Department of Gastroenterology & Hepatology, University of Utah Health School of Medicine, Salt Lake City, UT, USA

    Babu P. Mohan

Authors
  1. Hassam Ali
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  2. Pratik Patel
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  3. Jeffery Lowell
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  4. Dushyant Singh Dahiya
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  5. Sukhvir Singh
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  6. Ahmed Sami Hammami
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  7. Shiva Poola
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  8. William Leland
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  9. Douglas G. Adler
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Contributions

HA, PP, WL, BPM Conceptualization, Methodology, Software, Data curation, Validation, Writing—Original draft preparation. HA, JL, DSD, ASH, SP: Writing—Reviewing and Editing, Project administration. HA, DSD, DGA, BPM: Writing—Reviewing and Editing, Supervision.

Corresponding author

Correspondence to Hassam Ali.

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Conflict of interest

The authors certify that they have NO affiliations with or involvement in any organization or entity with any financial interest. The authors declare that they have no conflicts of interest.

Ethical approval

Institutional IRB approval was not obtained for this study as the nationwide readmission database is a third party de-identified retrospective database which is publicly accessible.

Informed consent

Not required due to retrospective de-identified data analysis.

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An editorial commenting on this article is available at https://doi.org/10.1007/s10620-023-08040-x.

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Ali, H., Patel, P., Lowell, J. et al. Delaying Cardiac Catheterization in Favor of Endoscopy in Non-ST Elevation Myocardial Infarction Patients Is Associated with Worse Outcomes: A Nationwide Analysis. Dig Dis Sci 68, 3913–3920 (2023). https://doi.org/10.1007/s10620-023-08033-w

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