‘No compelling evidence’ for fecal occult blood testing prior to cardiac catheterization
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LAS VEGAS — Patients with acute coronary syndrome had similar outcomes for all-cause mortality and bleeding events regardless of undergoing fecal occult blood tests, according to a presentation at the ACG Annual Scientific Meeting.
“Fecal occult blood testing is not recommended in the in-patient setting,” Lauren Searls, DO, of the Charleston Area Medical Center and West Virginia University School of Medicine, said during the presentation. “However, we note that it’s often ordered to assess for gastrointestinal blood loss. In the in-patient setting, FOBT increases GI consults, increases the rate of endoscopic intervention and has a high type 1 error reported in the literature at up to 50%.”
“Our study aimed to assess the difference in outcomes in patients receiving fecal occult blood testing in the setting of non-ST-elevation myocardial infarction (NSTEMI),” Searls added.
Searls and colleagues retrospectively compared the TriNetX national data of 46,349 patients aged 18 to 90 years who received cardiac catheterization during hospitalization between Jan. 1, 2019, and Dec. 31, 2020, categorizing them based on whether fecal occult blood testing (FOBT) was administered before catheterization. Data were propensity-matched by race, sex and comorbidities.
Results showed 3.7% of patients who underwent cardiac catheterization received FOBT prior to catheterization.
“Of those patients, the patients receiving fecal occult blood testing overall had higher age, increased BMI and increased risk of risk factors such as hypertension, coronary artery disease, heart failure, diabetes and chronic obstructive pulmonary disease,” Searls said.
The FOBT group had lower troponin levels than the non-FOBT group (0.41 versus 0.95; P = .04).
Within 30 days, both groups had similar rates of all-cause mortality (4.45% versus 4.01%), bleeding events (0.98% versus 0.69%) and length of stay (14.1 days versus 14.2 days).
In 233 patients who underwent FOBT and endoscopic evaluation, there was no significant difference in mortality, Searls said.
“We concluded that there is no compelling evidence to perform fecal occult blood testing in a setting of NSTEMI,” Searls said. “In the future, further assessment is needed to determine whether fecal occult blood testing or endoscopy delayed time to cardiac catheterization.”
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Searls L. Outcomes of Hospitalized Patients With Fecal Occult Positive Stool Prior to Cardiac Catheterization in ACS. Presented at: ACG Annual Scientific Meeting; Oct. 22-27, 2021; Las Vegas (hybrid meeting).
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