Copyright
©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
Safety of gastrointestinal endoscopy in patients with acute coronary syndrome and concomitant gastrointestinal bleeding
Ahmed A Elkafrawy, Mohamed Ahmed, Mohammad Alomari, Ahmed Elkaryoni, Kevin F Kennedy, Wendell K Clarkston, Donald R Campbell
Ahmed A Elkafrawy, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, United States
Ahmed A Elkafrawy, Mohamed Ahmed, Internal Medicine, University of Missouri Kansas City School of Medicine, Kansas City, MO 64108, United States
Mohammad Alomari, Department of Gastroenterology and Hepatology, Cleveland Clinic Florida, Weston, FL 33331, United States
Ahmed Elkaryoni, Division of Cardiovascular Medicine, Loyola University Medical Center and Stritch School of Medicine, Maywood, IL 60153, United States
Kevin F Kennedy, Mid America Heart Institute, Saint Luke's Health System, Kansas City, MO 64111, United States
Wendell K Clarkston, Donald R Campbell, Department of Gastroenterology, Saint Luke's Hospital/University of Missouri Kansas City, Kansas City, MO 64111, United States
Author contributions: Campbell DR and Clarkston WK were the study's senior authors; they contributed to interpreting the data, writing, critical reviewing, and editing of the manuscript; Elkafrawy AA contributed to the conception, study design, literature review, and drafting of the manuscript; Ahmed M and Alomari M performed the literature review and drafted the manuscript; Elkaryoni A contributed to the study design and to develop the analytic plan; Kennedy KF extracted the data and performed the statistical analysis; all authors reviewed and approved the final manuscript.
Institutional review board statement: The study population was identified from the Healthcare Cost and Utilization Project databases (HCUP). The HCUP databases are sponsored by the Agency for Healthcare Research and Quality. The Nationwide Inpatient Sample (NIS) database is the largest HCUP database, and it contains unweighted data from over 7 million hospital admission each year. The data represent a 20% random sample of participating hospital discharges from 46 states. The NIS database is de-identified and available to the public. Thus, it is not considered human subject research and is exempted from review by the institutional review board.
Informed consent statement: The study population was identified from the Healthcare Cost and Utilization Project databases (HCUP). The HCUP databases are sponsored by the Agency for Healthcare Research and Quality. The Nationwide Inpatient Sample (NIS) database is the largest HCUP database, and it contains unweighted data from over 7 million hospital admission each year. The data represent a 20% random sample of participating hospital discharges from 46 states. The NIS database is de-identified and available to the public. Thus, no informed consents were required or obtained.
Conflict-of-interest statement: The authors declare that they have no conflict-of-interest.
Data sharing statement: The study was conducted from the Nationwide Inpatient Sample Database (NIS). The NIS is a public database that contains de-identified data from hospitalized patients in the US. There is no risk of identification of patients.
STROBE statement: The authors have read the STROBE checklist, and the manuscript was prepared and revised according to the STROBE checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
http://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Ahmed A Elkafrawy, MD, Academic Fellow, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, A50, Cleveland, OH 44195, United States. ahmed.aly.kafrawy@gmail.com
Received: July 24, 2020
Peer-review started: July 24, 2020
First decision: September 14, 2020
Revised: October 1, 2020
Accepted: January 6, 2021
Article in press: January 6, 2021
Published online: February 16, 2021
ARTICLE HIGHLIGHTS
Research background
Gastrointestinal bleeding (GIB) in patients with acute coronary syndrome (ACS) is reported to be associated with increased morbidity and mortality.
Research motivation
Large scale studies investigating the safety profile and hospitalization outcomes of undergoing gastrointestinal endoscopic (GIE) procedure in hospitalized patients with ACS and GIB are limited and conflicting.
Research objectives
This large scale study assesses the safety and utility of performing GIE in hospitalized patients with concomitant ACS and GIB.
Research methods
The Nationwide Inpatient Sample database was queried to identify patients hospitalized with ACS and GIB during the same admission between 2005 and 2014 using ICD-9 codes. The study cohort was further categorized into two groups based on undergoing GIE. Outcomes of interest were compared between both groups. Multivariate analysis was conducted to predict factors associated with increased mortality and prolonged length of stay.
Research results
Patients with both ACS and GIB during the same admission who underwent GIE had a lower mortality rate (3.8%) in comparison to the group without endoscopy (8.6 %). Patients who underwent GIE had a shorter hospital stay (mean 6.59 ± 7.81 d) contrasted to those not undergoing endoscopic procedure (mean 7.84 ± 9.73 d). Multivariate regression analysis showed that undergoing GIE in this cohort was an independent predictor of lower mortality and shorter hospital stay.
Research conclusions
Undergoing GIE in patients presenting with ACS and GIB during the same index admission was associated with lower mortality as well as a shorter hospital stay.
Research perspectives
Future prospective studies are needed to evaluate the optimal time for intervention in patients with concomitant ACS and GIB and whether different modalities of endoscopy and endoscopic interventions are equally safe.
