Reappraisal of Upper Gastrointestinal Bleeding Prevalence in Acute Myocardial Infarct Patients Undergoing Urgent Coronary Angiography
Bibliographic record
Abstract
Purpose: Acute myocardial infarct (MI) patients have never been targeted as patients at high risk for clinically significant gastrointestinal bleeding (CSGB). Because of the stress attributed to this condition and the related therapeutic procedures, the hemodynamic changes and the intensive use of early combined anticoagulant treatments, we believe that this population is at an increased risk for upper gastrointestinal bleeding. The objective of this study is to evaluate the prevalence of CSGB in acute MI patients undergoing urgent coronary angiography using the criteria currently used in the gastroenterological literature. Methods: Using the archives of the Centre Hospitalier Universitaire de Sherbrooke, a historic cohort of all patients diagnosed with a MI who also underwent a coronary angiography between April 1996 and April 2003 was reviewed (1174 patients). Patients with a concurrent diagnosis of upper gastrointestinal bleeding (79 patients) were then selected and screened for CSGB criteria. Patients undergoing non-urgent (>72 hours after diagnosis) and non-therapeutic intended urgent coronary angiography were excluded. All anticoagulant medication and acid-suppressing drugs were listed in the remaining. Results: Clinically significant gastrointestinal bleeding showed an increasing trend through the years with an prevalence of 4.4% in the latest 2 years. A total of 25 cases of clinically significant gastrointestinal bleeding were identified through the six years reviewed with about half the cases (11 cases) in the latest two years. Of these, 92% received a minimum of 3 anticoagulant drugs and nearly half received 4 or more agents. A glycoprotein IIbIIIa inhibitor was administered in 11 of the 25 patients and clopidogrel was used in an increasing trend since 1999. Interestingly, only a quarter of the patients received acid-suppressing agents before their bleeding. Conclusions: Patients undergoing urgent coronary angiography for an acute MI seem to be at high risk for clinically significant gastrointestinal bleeding. The use of early combined multiple anticoagulant drugs could explane the number of bleeding episodes. These results indicate a possible new indication for gastroprotective therapy. A prospective study evaluating the effect of gastroprotective measures in this population is currently undertaken.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.003 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".