Safety of gastrointestinal endoscopy in patients with acute coronary syndrome and concomitant gastrointestinal bleeding

Table 1 Comparison between 2 groups regarding undergoing gastrointestinal endoscopy

	Total (n = 269483)	Patients underwent endoscopy (n = 183409)	Patients without endoscopy (n = 86073)	P value
Mean age at admission	72.32 ± 11.72	72.82 ± 11.41	71.27 ± 12.29	< 0.001
Males	178111 (66.1)	120040 (65.4)	58070 (67.5)	< 0.001
Females	91372 (33.9)	63369 (34.6)	28003 (32.5)
Race				< 0.001
Caucasian	185713 (79.1)	127623 (79.5)	58089 (78.1)
African American	17453 (7.4)	11555 (7.2)	5898 (7.9)
Hispanic	16362 (7.0)	10710 (6.7)	5652 (7.6)
Other	15338 (6.5)	10639 (6.6)	5652 (7.6)
Mortality	14448 (5.4)	7027 (3.8)	7421 (8.6)	< 0.001
Length of stay	6.99 ± 8.49	6.59 ± 7.81	7.84 ± 9.73	< 0.001
Primary expected payer				< 0.001
Medicare	198925 (73.9)	137580 (75.1)	61344 (71.4)
Medicaid	12590 (4.7)	7864 (4.3)	4726 (5.5)
Private	45991 (17.1)	30558 (16.7)	15433 (18.0)
Self-pay	6407 (2.4)	3900 (2.1)	2507 (2.9)
No charge	578 (0.2)	318 (0.2)	261 (0.3)
Other	4642 (1.7)	2971 (1.6)	1672 (1.9)
Location/teaching status of hospital				< 0.001
Rural	26040 (9.7)	19100 (10.5)	6939 (8.1)
Urban nonteaching	119321 (44.5)	82796 (45.4)	6939 (8.1)
Urban teaching	122779 (45.8)	80650 (44.2)	42129 (49.2)
Region of hospital				0.022
Northeast	49463 (18.4)	34252 (18.7)	15212 (17.7)
Midwest	64974 (24.1)	44079 (24.0)	20895 (24.3)
South	100860 (37.4)	68653 (37.4)	20895 (24.3)
West	100860 (37.4)	68653 (37.4)	17759 (20.6)
Shock	24171 (9)	13172 (7.2)	10999 (12.8)	< 0.001
Mechanical ventilation	24705 (9.2)	12736 (9.2)	11969 (13.9)	< 0.001
Blood transfusion	145939 (54.2)	102484 (55.9)	43455 (50.5)	< 0.001

Table 1 compares demographics and main outcomes between patients who underwent gastrointestinal endoscopy and the group who did not undergo endoscopy. Values are presented as n (%).

Table 2 Predictors of mortality (multivariate analysis)

	Odds ratio, 95%CI	P value
GIE	0.58 (0.53, 0.63)	< 0.0001
Age	1.03 (1.03, 1.03)	< 0.0001
Female	0.99 (0.9, 1.08)	0.7729
Race (Caucasian)	0.9 (0.83, 0.99)	0.0225
DM	0.71 (0.64, 0.79)	< 0.0001
CHF	1.13 (1.02, 1.26)	0.0186
Coagulopathy	1.76 (1.57, 1.98)	< 0.0001
Anemia	0.85 (0.76, 0.96)	0.0069
Liver disease	1.75 (1.51, 2.02)	< 0.0001
Renal failure	1.32 (1.2, 1.44)	< 0.0001
Diagnosis of cancer	1.76 (1.41, 2.19)	< 0.0001
Shock	3.03 (2.72, 3.38)	< 0.0001
Mechanical ventilation	9.16 (8.33, 10.07)	< 0.0001
Blood transfusion	0.9 (0.82, 0.99)	0.0314
Tobacco smoking	0.71 (0.63, 0.8)	< 0.0001
Alcohol abuse	1.19 (1.01, 1.41)	0.0400

Multivariate logistic regression model for predictors of mortality in patients hospitalized with acute coronary syndrome and concomitant gastrointestinal bleeding. Performing gastrointestinal endoscopy was included along with other variables and comorbidities that can affect mortality. GIE: Gastrointestinal endoscopy; DM: Diabetes mellitus; CHF: Congestive heart failure.

Table 3 Factors associated with length of stay (multivariate analysis)

Label	Beta weight, 95%CI for LOS	P value
GIE	-0.36 (-0.56, -0.16)	< 0.001
Age	-0.01 (-0.02, 0)	0.0059
Sex (female)	0.34 (0.2, 0.48)	< 0.0001
Race (Caucasian)	-0.47 (-0.62, -0.32)	< 0.0001
DM	-0.8 (-0.95, -0.66)	< 0.0001
CHF	1.57 (1.35, 1.8)	< 0.0001
Coagulopathy	1.39 (1.04, 1.74)	< 0.0001
Anemia	0.07 (-0.11, 0.26)	0.4333
Liver disease	0.28 (-0.05, 0.61)	0.0945
Renal failure	1.41 (1.24, 1.59)	< 0.0001
Diagnosis of cancer	0.56 (0.08, 1.04)	0.0228
Shock	3.16 (2.73, 3.59)	< 0.0001
Mechanical ventilation	8.48 (7.96, 9)	< 0.0001
Blood transfusion	-0.69 (-0.9, -0.49)	< 0.0001
Tobacco smoking	-1.58 (-1.77, -1.38)	< 0.0001
Alcohol abuse	-0.77 (-1.08, -0.47)	< 0.0001

Multivariate logistic regression model for predictors of length of stay (LOS) in patients hospitalized with acute coronary syndrome and concomitant gastrointestinal bleeding. Performing gastrointestinal endoscopy was included along with other variables and comorbidities that can affect LOS. LOS: length of stay; GIE: Gastrointestinal endoscopy; DM: Diabetes mellitus; CHF: Congestive heart failure.