Utility of urgent esophagogastroduodenoscopy in acute upper gastrointestinal bleeding concomitant with acute coronary syndrome Travel Award

Background: Upper gastrointestinal bleeding (UGIB) is frequently encountered during acute coronary syndrome (ACS). Esophagogastroduodenoscopy (EGD) during ACS also raises concerns about complications. We aim to identify factors that might predict patients who might benefit from urgent EGD.
Methods: A retrospective study was conducted on ACS patients with UGIB who underwent urgent EGD. Cirrhosis, platelet<50,000, or recent UGIB were excluded. Participants were divided into two groups: those who received hemostatic interventions and those who did not. We collected demographic data, details on ACS treatment, UGIB management, and outcomes. Logistic regression was applied to identify significant factors.
Results: Among 102 patients (mean age 73 years, 58.8% female), 34 patients in intervention group, and 68 patients in non-intervention group. Non-ST elevation myocardial infarction (NSTEMI) was the most common type of ACS. The primary causes of bleeding were acid-related conditions and vascular lesions. No malignant lesions or complications related to endoscopy were observed. The use of non-steroidal anti-inflammatory drugs (NSAIDs) (odds ratio (OR) 14.63), presence of hematemesis (OR 4.66), and the absence of thrombotic therapy during ACS (OR 4.91) were associated with a higher likelihood of receiving intervention.
Conclusion: ACS patients with concomitant UGIB who use NSAID, present with hematemesis, or do not receive thrombotic therapy are more likely to undergo intervention. These findings help prioritize patients who may benefit from urgent EGD.