INTRODUCTION Patients hospitalized with myocardial infarction (MI) are at risk of gastrointestinal bleeding because of the need for antiplatelet agents and/or anticoagulation. The data regarding the safety of endoscopy after MI are limited. This study sought to assess mortality rates of patients hospitalized with acute MI who require esophagogastroduodenoscopy or colonoscopy using the National Inpatient Sample (NIS) database. METHODS A retrospective cohort analysis of all adult inpatients in the NIS from 2016 admitted for ST-elevation infarction myocardial infarction (STEMI), non-STEMI, or type II non-STEMI was conducted. Data were collected including patient demographics and indication for endoscopy per ICD-10 coding. HCUPnet was used to query NIS to obtain all inpatient mortality. The primary methods included adjusted χ for categorical outcomes, adjusted linear regression for continuous outcomes, and adjusted logistic regression for multivariable analysis. RESULTS A total of 1,281,749 patients were admitted for acute coronary syndrome in 2016, and 55,035 of these patients underwent endoscopy In the multivariable regression analysis, those who underwent a GI procedure (odds ratio [OR] 0.80, P value < 0.002) and angiogram (OR 0.48, P value < 0.001) had lower in-hospital mortality, after adjusting for age, Elixhauser index, need for angiogram, sex, race, and hospital type. Endoscopy postcatheterization was not associated with a difference in mortality compared with preangiogram (OR = 0.84, 95% confidence interval 0.60-1.19). DISCUSSION Patients who underwent endoscopy are sicker and have higher mortality rates than those who do not undergo endoscopy, but after adjusting for comorbidities, mortality is actually lower. This suggests that endoscopy is safe and should be performed when clinically indicated despite recent cardiac ischemia.

中文翻译：

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急性心肌梗死住院患者内镜检查的安全性

引言 因心肌梗死 (MI) 住院的患者由于需要抗血小板药物和/或抗凝剂而有胃肠道出血的风险。关于 MI 后内窥镜检查安全性的数据是有限的。本研究旨在使用国家住院样本 (NIS) 数据库评估需要进行食管胃十二指肠镜检查或结肠镜检查的急性 MI 住院患者的死亡率。方法 对 2016 年以来 NIS 中所有因 ST 段抬高心肌梗死 (STEMI)、非 STEMI 或 II 型非 STEMI 入院的成年住院患者进行回顾性队列分析。收集的数据包括患者人口统计数据和根据 ICD-10 编码进行内窥镜检查的指征。HCUPnet 用于查询 NIS 以获取所有住院死亡率。主要方法包括针对分类结果的调整 χ，连续结果的调整线性回归和多变量分析的调整逻辑回归。结果 2016 年共有 1,281,749 名患者因急性冠脉综合征入院，其中 55,035 名患者接受了内镜检查。在多变量回归分析中，接受胃肠道手术（OR 0.80，P 值 < 0.002）和血管造影（ OR 0.48，P 值 < 0.001）在调整年龄、Elixhauser 指数、血管造影需要、性别、种族和医院类型后，院内死亡率较低。与血管造影前相比，内镜检查后导管插入与死亡率差异无关（OR = 0.84，95% 置信区间 0.60-1.19）。讨论 接受内窥镜检查的患者比未接受内窥镜检查的患者病情更重，死亡率更高，但在调整合并症后，死亡率实际上更低。这表明内窥镜检查是安全的，尽管最近有心脏缺血，但应在有临床指征时进行。