Management of Patient with Simultaneous Overt Gastrointestinal Bleeding and Myocardial Infarction with ST Segment Elevation: A Case Report

Background: The current ERC guidelines have resulted in numerous positive changes, including a reduction in mortality, length of hospitalization, and an improvement in the prognosis of STEMI patients. However, there is a small group of patients for whom a minor change in guidelines would reduce in-hospital mortality and hospitalization costs even further. These are patients who have a STEMI infarction as well as gastrointestinal bleeding.

Methods: In patients with concomitant gastrointestinal bleeding and ST segment elevation myocardial infarction, two treatment methods were compared. The first is a traditional approach that adheres to ESC guidelines, while the second is innovative and priorities endoscopy.

Results: Despite the novel approach, the patient who underwent endoscopy prior to PCI was discharged without complications. A patient who underwent coronary intervention and was started on standard antiplatelet therapy prior to a gastroenterological diagnosis died as a result of massive bleeding.

Conclusion: For ethical reasons and in accordance with the cardiological guidelines of the management of ACS, a study of patients with ASC a high risk of intestinal bleeding , in which endoscopy will have priority, and only later PCI, will probably never be performed. However, as demonstrated by the described case, despite exceeding the 90-minute time limit for implementing PCI (120-minutes), such behavior is entirely feasible.