Short-term prognosis and clinical characteristics of patients with acute myocardial infarction complicated with upper gastrointestinal bleeding after endoscopic therapy

Li Shuwei; Sun Yamei; Zhang Jie

doi:10.3760/j.issn.1673-4777.2026.07.003

Abstract：Objective To explore the short-term prognosis and clinical characteristics of patients with acute myocardial infarction(AMI)complicated with upper gastrointestinal bleeding after endoscopic therapy,and to identify the safe conditions for endoscopic treatment and key prognostic factors.Methods A total of 64 patients admitted to Beijing Anzhen Hospital,Capital Medical University from January 2012 to August 2025 with AMI combined with upper gastrointestinal bleeding who received successful endoscopic hemostasis were retrospectively enrolled.Clinical data including general information,medical history,laboratory examinations,cardiac and bleeding characteristics,and clinical outcomes were collected.The primary endpoint was all-cause mortality within 30 d after successful endoscopic hemostasis.Patients were divided into survival group(44 cases)and death group(20 cases)for comparative analysis.Results The age of the 64 patients was(63±13)years old,among whom 79.7％(51/64)were male.Non-ST-segment elevation myocardial infarction accounted for 60.9％(39 cases),and ST-segment elevation myocardial infarction accounted for 39.1％(25 cases).Cardiac insufficiency was present in 53.1％(34 cases)on admission.All patients achieved successful endoscopic hemostasis without intraoperative complications.During the 30 d follow-up period,44 patients(68.8％)survived and 20 patients(31.2％)died,among whom 95.0％(19/20)died of cardiac causes after successful hemostasis.Due to severe underlying cardiac diseases in the death group,the proportions of patients receiving mechanical ventilation,intra-aortic balloon pump,extracorporeal membrane oxygenation and continuous renal replacement therapy were significantly higher than those in the survival group[80.0％(16/20)vs 25.0％(11/44),35.0％(7/20)vs 9.1％(4/44),45.0％(9/20)vs 4.5％(2/44),40.0％(8/20)vs 0(0/44)](all P＜0.05).Conclusions Most patients with AMI combined with upper gastrointestinal bleeding undergoing endoscopic hemostasis are complicated with cardiac insufficiency.The application of advanced life support contributes to hemodynamic stability and guarantees the safe implementation of endoscopic hemostasis,while it also reflects critical illness severity.The prognosis of patients is determined by the severity of underlying cardiac lesions.