Acute Myocardial Injury in Patients Presenting With Upper Gastrointestinal Bleeding: Prevalence, Predictors, Troponin Dynamics, and In-Hospital Outcomes.
8 affiliations
- 1General Internal Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, GBR.
- 2Gastroenterology and Hepatology, Pakistan Kidney and Liver Institute and Research Center, Rawalpindi, PAK.
- 3Acute Medicine, Royal Albert Edward Infirmary, Wigan, GBR.
- 4Cardiac Surgery, Ghurki Trust Teaching Hospital, Lahore, PAK.
- 5Medicine, Punjab Rangers Teaching Hospital, Lahore, PAK.
- 6Anesthesia and Critical Care, Shalamar Hospital, Lahore, PAK.
- 7Public Health, University of Lahore, Lahore, PAK.
- 8General Surgery, Mayo Hospital, Lahore, PAK.
Abstract
Upper gastrointestinal bleeding (UGIB) may cause anemia, hypovolemia, and hemodynamic compromise, potentially contributing to myocardial injury during the acute illness. Troponin elevation in this setting requires careful interpretation because an isolated measurement cannot reliably distinguish acute injury from elevation without qualifying change or establish myocardial infarction. The frequency, temporal evolution, and clinical significance of acute myocardial injury in patients with UGIB remain incompletely characterized. This prospective multicenter study evaluated its prevalence, associated admission factors, serial troponin dynamics, and relationship with in-hospital outcomes, including subsequent mortality among patients surviving the first 24 hours. This prospective multicenter observational cohort study enrolled 1,000 adults at tertiary care hospitals in Punjab, Pakistan, between January 2025 and August 2026. Cardiac troponin I measurements were scheduled at presentation, 3-6 hours, and 20-24 hours. Acute injury required a concentration above the applicable 99th-percentile reference limit and a serial maximum-minimum range of ≥10 ng/L and ≥20% of the earliest observed concentration, using at least two measurements spanning ≥3 hours. Prevalence was estimated with Wilson confidence intervals (CIs). Multivariable logistic regression examined admission factors associated with injury. A 24-hour landmark analysis evaluated subsequent mortality among patients alive and still hospitalized with classifiable injury status. Injury status was classifiable in 960 patients; 104 had acute injury, giving a prevalence of 10.8% (95% CI: 9.0-13.0%). A further 131 patients (13.6% of classifiable assessments) had troponin elevation without qualifying change, while 40 assessments were indeterminate. Older age (adjusted odds ratio (aOR) per decade: 1.40; 95% CI: 1.21-1.63), coronary artery disease (aOR: 1.82; 95% CI: 1.06-3.10), and lower hemoglobin (aOR per 1 g/dL decrease: 1.27; 95% CI: 1.06-1.51) were associated with acute injury. Fourteen acute-injury cases (13.5%) first met the classification criterion at the late measurement. Among 810 landmark patients with known outcomes, 34 died. Subsequent mortality was 15.2% with acute injury versus 2.8% without acute injury (aOR: 3.47; 95% CI: 1.58-7.62; p=0.002). An adverse differential assignment of unresolved mortality outcomes attenuated this association (aOR: 1.86; 95% CI: 0.94-3.69). Acute myocardial injury affected approximately one in 10 classifiable patients with UGIB and was associated with older age, coronary artery disease, lower hemoglobin, and higher subsequent in-hospital mortality. Serial measurements distinguished acute changes from elevation without qualifying change. The mortality association requires cautious interpretation because of limited events, residual confounding, and incomplete follow-up.
Related
- Prevalence, causes, and predictors of 30-day readmissions after acute myocardial infarction with ventricular arrhythmias: a cohort study using the 2016–2017 national readmissions database
- Prognostic value of scoring systems in geriatric patients receiving warfarin presenting with upper gastrointestinal bleeding
- Intelligent thermoregulation strategy versus routine thermal management on myocardial injury after noncardiac surgery during gastrointestinal tumor resection in elderly patients (SAGE): a multicenter, parallel-group, superiority trial.
- Vertebral artery injury in patients presenting to the emergency department with cervical spine fractures: national trends, predictors, and cerebrovascular outcomes.
- Endoscopic intervention is associated with a lower risk of in-hospital mortality in patients with acute myocardial infarction complicated by gastrointestinal bleeding.
BibTeX
@article{abbas2026acute,
title = {{Acute Myocardial Injury in Patients Presenting With Upper Gastrointestinal Bleeding: Prevalence, Predictors, Troponin Dynamics, and In-Hospital Outcomes.}},
author = {Nayyar Abbas and Fatima N Shahid and Rameesha Amjad and Muhammad Waleed Amjad and Samia Samar Arooj and Saadia Sehrish and Aamir Bashir and Mehak Yusuf and Aymen Shafiq and Sharjeel Mahmood},
journal = {Cureus},
year = {2026},
month = nov,
doi = {10.7759/cureus.119221},
url = {https://europepmc.org/article/MED/42997480},
note = {CC BY},
}
RIS
TY - JOUR
TI - Acute Myocardial Injury in Patients Presenting With Upper Gastrointestinal Bleeding: Prevalence, Predictors, Troponin Dynamics, and In-Hospital Outcomes.
AU - Nayyar Abbas
AU - Fatima N Shahid
AU - Rameesha Amjad
AU - Muhammad Waleed Amjad
AU - Samia Samar Arooj
AU - Saadia Sehrish
AU - Aamir Bashir
AU - Mehak Yusuf
AU - Aymen Shafiq
AU - Sharjeel Mahmood
PY - 2026
DA - 2026/11/06
JO - Cureus
DO - 10.7759/cureus.119221
UR - https://europepmc.org/article/MED/42997480
AB - Upper gastrointestinal bleeding (UGIB) may cause anemia, hypovolemia, and hemodynamic compromise, potentially contributing to myocardial injury during the acute illness. Troponin elevation in this setting requires careful interpretation because an isolated measurement cannot reliably distinguish acute injury from elevation without qualifying change or establish myocardial infarction. The frequency, temporal evolution, and clinical significance of acute myocardial injury in patients with UGIB remain incompletely characterized. This prospective multicenter study evaluated its prevalence, associated admission factors, serial troponin dynamics, and relationship with in-hospital outcomes, including subsequent mortality among patients surviving the first 24 hours. This prospective multicenter observational cohort study enrolled 1,000 adults at tertiary care hospitals in Punjab, Pakistan, between January 2025 and August 2026. Cardiac troponin I measurements were scheduled at presentation, 3-6 hours, and 20-24 hours. Acute injury required a concentration above the applicable 99th-percentile reference limit and a serial maximum-minimum range of ≥10 ng/L and ≥20% of the earliest observed concentration, using at least two measurements spanning ≥3 hours. Prevalence was estimated with Wilson confidence intervals (CIs). Multivariable logistic regression examined admission factors associated with injury. A 24-hour landmark analysis evaluated subsequent mortality among patients alive and still hospitalized with classifiable injury status. Injury status was classifiable in 960 patients; 104 had acute injury, giving a prevalence of 10.8% (95% CI: 9.0-13.0%). A further 131 patients (13.6% of classifiable assessments) had troponin elevation without qualifying change, while 40 assessments were indeterminate. Older age (adjusted odds ratio (aOR) per decade: 1.40; 95% CI: 1.21-1.63), coronary artery disease (aOR: 1.82; 95% CI: 1.06-3.10), and lower hemoglobin (aOR per 1 g/dL decrease: 1.27; 95% CI: 1.06-1.51) were associated with acute injury. Fourteen acute-injury cases (13.5%) first met the classification criterion at the late measurement. Among 810 landmark patients with known outcomes, 34 died. Subsequent mortality was 15.2% with acute injury versus 2.8% without acute injury (aOR: 3.47; 95% CI: 1.58-7.62; p=0.002). An adverse differential assignment of unresolved mortality outcomes attenuated this association (aOR: 1.86; 95% CI: 0.94-3.69). Acute myocardial injury affected approximately one in 10 classifiable patients with UGIB and was associated with older age, coronary artery disease, lower hemoglobin, and higher subsequent in-hospital mortality. Serial measurements distinguished acute changes from elevation without qualifying change. The mortality association requires cautious interpretation because of limited events, residual confounding, and incomplete follow-up.
SN - 2168-8184
ER -