Effectiveness of endoscopy in patients with concomitant gastrointestinal bleeding and acute coronary syndrome: A systematic review
Notice bibliographique
Résumé
BACKGROUND: Gastrointestinal bleeding (GIB) is a critical complication often seen in patients with acute coronary syndrome (ACS), especially those undergoing dual antiplatelet therapy. GIB is associated with increased mortality and prolonged hospitalization, particularly in ACS patients. Despite advancements in management strategies, the role of gastrointestinal endoscopy (GIE) in this population remains controversial, with concerns about timing, safety, and clinical outcomes. AIM: To evaluate the safety and efficacy of GIE in patients with ACS and acute GIB, focusing on outcomes such as mortality, hospital length of stay (LOS), hemorrhage control, rebleeding, and blood transfusion requirements. METHODS: Following Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, a systematic review was conducted using databases including PubMed, Cochrane, and EMBASE, up to December 2024. The protocol was registered with the International Prospective Register of Systematic Reviews (CRD42025630188). Study quality was assessed using the Cochrane Risk of Bias 2.0 tool for randomized controlled trials (RCTs) and the Newcastle-Ottawa Scale for cohort studies. RESULTS: Four studies met the inclusion criteria, comprising one RCT and three cohort studies with a total population of 1676130 patients. Most studies indicated that GIE was associated with improved survival in ACS patients with GIB. Three of our studies reported lower mortality rates in patients undergoing GIE compared to those managed without endoscopy, although this varied by study. While GIE demonstrated effectiveness in controlling hemorrhage and reducing rebleeding rates in one study. The rest of the studies did not evaluate these outcomes comprehensively. Hospital LOS outcomes were inconsistent, with two studies suggesting no significant difference, while only one study indicated potential reductions in LOS with GIE. Blood transfusion requirements were reported in one study to be higher in patients undergoing GIE, reflecting its frequent use in severe cases. The safety and effectiveness of GIE varied depending on patient characteristics, timing of the procedure, and type of intervention. CONCLUSION: GIE has the potential to improve survival in certain patients with ACS complicated by GIB; however, determining the ideal timing and appropriate candidates necessitates careful individual assessment. While evidence suggests benefits, the limitations of observational studies warrant caution. Collaboration between cardiology and gastroenterology is essential to optimizing outcomes. Future randomized trials should focus on timing, severity, and diverse populations to refine guidelines and improve care for this high-risk group.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,002 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».