Upper Gastrointestinal Bleeding Associated with Myocardial Injury in Egyptian Patients: Frequency and Risk Factors

Abstract

AIM: The frequency and risk factors of myocardial injury after upper gastrointestinal bleeding in our community are unknown. The aim of this study was to investigate the frequency of myocardial injury in patients with first episode of upper gastrointestinal bleeding and to determine the risk factors for this simultaneous affection. METHOD: One hundred and five patients with first episode of upper gastrointestinal bleeding were included. All patients were subjected to thorough history taking, clinical examination, routine investigations, treatment with blood transfusion and pharmacologic agents, abdominal ultrasonography, upper GIT endoscopy and studies of myocardial injury including electrocardiography (ECG), transthoracic echocardiography (TTE) and cardiac enzymes including creatine kinase (CK), creatine kinase-MB (CK-MB) and Troponin I (TnI). All patients were assessed for occurrence of myocardial injury, determination of risk factors and length of hospital stay. RESULTS: A total of 39 patients (37.1%) developed myocardial injury. Patients with first episode of upper gastrointestinal bleeding with a history of liver cirrhosis, systemic hypertension, smoking, high body mass index (BMI) and hypertriglyceridaemia had a high risk of developing myocardial injury and longer hospital stay. Increased C-reactive protein, CK, CK-MB and Troponin I and deviated ST segment-T wave of ECG were the markers of this injury. CONCLUSION: 37.1% of adult patients with first episode of upper gastrointestinal bleeding developed myocardial injury. Liver cirrhosis, smoking, systemic hypertension and higher BMI were the predictors of this injury.