Key result
Overt versus occult GIB in ACS is linked to ~2.7-fold higher endoscopically actionable findings.
Why the study?
Although endoscopy is commonly performed when gastrointestinal bleeding occurs during ACS hospitalisation, the clinical yield and actionable findings may differ between overt and occult bleeding presentations, and data comparing these phenotypes in ACS patients remain limited.
Does overt gastrointestinal bleeding presentation increase the likelihood of endoscopically actionable findings compared to occult presentation in adults with acute coronary syndrome undergoing endoscopy within 30 days?
Cohort (n=119)
No
Does overt gastrointestinal bleeding presentation increase the likelihood of endoscopically actionable findings compared to occult presentation in adults with acute coronary syndrome undergoing endoscopy within 30 days?
In ACS patients with gastrointestinal bleeding undergoing endoscopy within 30 days, actionable findings are common in both phenotypes, with overt bleeding independently associated with a higher likelihood of management-changing pathology.
Answers are grounded in this paper and cite their sources.
Overt GIB may warrant prioritized endoscopy in ACS; leaves open whether bleeding type should guide selection or urgency in future protocols.
Background Acute coronary syndrome (ACS) requires prompt antithrombotic therapy, which increases the risk of gastrointestinal bleeding (GIB). When GIB occurs during ACS hospitalisation, clinicians face a therapeutic dilemma between bleeding control and continuation of cardioprotective treatment. Although endoscopy is commonly performed in this setting, the clinical yield and actionable findings may differ between overt and occult bleeding presentations. Data comparing these phenotypes in patients with ACS remain limited. Purpose To compare endoscopically actionable findings between ACS patients presenting with overt versus occult GIB. Methods We conducted a single-centre retrospective cohort study at Siriraj Hospital between 2011 and 2024. The study included adults admitted with ACS who were diagnosed with gastrointestinal bleeding and underwent endoscopy within 30 days. Patients were classified as overt or occult GIB. The primary endpoint was a pragmatic composite of endoscopically actionable outcomes at index endoscopy: endoscopic haemostasis, high-risk bleeding lesions, or a management-change lesions (defined as gastrointestinal cancer/tumour, inflammatory bowel disease, or colitis). Multivariable logistic regression was performed to identify predictors of the composite and management-change endpoints. Results Among 119 patients (overt n=84; occult n=35), the composite actionable endpoint occurred in 34.5% overall and was more frequent in overt versus occult GIB (40.5% vs 20.0%; OR 2.72, p=0.032). The difference was driven mainly by management-change lesions (19.0% vs 2.9%; OR 8.00, p=0.021), whereas high-risk bleeding lesions were similar between groups (16.7% vs 11.4%; p=0.467). In adjusted analyses, overt presentation remained independently associated with management-change lesions (Firth aOR 6.31, p=0.030) and showed a borderline association with the composite endpoint (Firth aOR 2.59, p=0.053). Conclusion In ACS patients undergoing endoscopy within 30 days of GIB diagnosis, actionable endoscopic findings were common in both bleeding phenotypes. Overt GIB was associated with a substantially higher likelihood of management-changing pathology, supporting timely endoscopic evaluation when clinically indicated.revisedSlide2
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Mahachai et al. (2026) conducted a cohort in Acute coronary syndrome with gastrointestinal bleeding (n=119). Overt gastrointestinal bleeding presentation vs. Occult gastrointestinal bleeding presentation was evaluated on Pragmatic composite of endoscopically actionable outcomes at index endoscopy (endoscopic haemostasis, high-risk bleeding lesions, or management-change lesions) (OR 2.72, p=0.032). Overt vs occult GIB presentation in ACS patients was associated with higher composite endoscopically actionable findings (40.5% vs 20.0%; OR 2.72, p=0.032; Firth aOR 2.59, p=0.053).
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