Upper endoscopy in patients with acute ST-elevation myocardial infarction (STEMI) and postthrombolysis upper gastrointestinal bleeding – results, therapeutic utility

Upper endoscopy is the “golden standard” for the diagnosis of upper gastrointestinal bleeding (UGB); it appreciates the persistence of bleeding in more than 90% of cases, it reveals the UGB lesion, gives prognostic information about re-bleeding risk and offers the possibility of endoscopic haemostasis. Uncomplicated STEMI by itself is not a contraindication for upper endoscopy [1,2]. The aim of our study was to observe the haemorrhagic lesions in STEMI patients with postthrombolysis UGB and to evaluate the safety and therapeutic utility of upper endoscopy in this category of patients. We performed upper endoscopy in STEMI patients with postthrombolytic UGB during a period of 4 years (1st of Jan 2008 - 31st of Dec 2011). Patients with systolic blood pressure (SBP) <100 mmHg, with Killip class>1, with unstable ECG and/or with severe associated conditions (respiratory distress, cerebrovascular stroke, consciousness disorders) were withdrawn from undergoing upper endoscopy, as well as patients who refused the investigation. During studied period, 618 STEMI patients underwent pharmacological coronary reperfusion. Postthrombolysis UGB occurred in 42 of them (6.79%). We could perform upper endoscopy in 30 patients (71.43%), the rest of 12 (28.57%) being withdrawn from endoscopy (6 patients with Killip class>1, 4 patients with systolic blood pressure<100mmHg, 2 patients refused the investigation). Incriminated haemorrhagic lesions were: erosive gastroduodenitis in 20 cases (66.67%) and duodenal ulcer in 10 cases (33.33%). As about therapeutic utility, amongst 30 patients investigated just 4 needed endoscopic treatment (haemoclips used in Forrest IB patients with duodenal ulcers). Endoscopy was a safe investigation in STEMI patients with postthrombolysis UGB. Erosive gastroduodenitis was incriminated as the source of bleeding in most of the cases. As it concerns the therapeutic utility of UE in STEMI patients with UGB, 13.33% of bleeding patients benefited from endoscopic treatment (mechanical haemmostasis).