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Silent myocardial ischaemia during endoscopic retrograde cholangiopancreatography
S D Johnston1, A McKenna, T C K Tham
1Division of Gastroenterology, Ulster Hospital Dundonald, Belfast, Northern Ireland, UK. simon.johnston@bch.n-i.nhs.uk
Insights
Myocardial ischaemia occurred in 22% of patients during endoscopic retrograde cholangiopancreatography (ERCP), often linked to sedation. Specific ERCP interventions did not increase the risk of this cardiac event.
Area of Science:
- Cardiology
- Gastroenterology
- Medical Procedures
Background:
- Myocardial ischaemia during endoscopic retrograde cholangiopancreatography (ERCP) is a potential risk.
- The incidence and risk factors for this complication require further investigation.
Purpose of the Study:
- To determine the incidence of myocardial ischaemia during ERCP, defined by ST changes on electrocardiography.
- To identify if specific ERCP interventions increase the risk of myocardial ischaemia.
Main Methods:
- Continuous Holter electrocardiograph monitoring was performed during ERCP in consecutive patients.
- ST depression was defined as > 1 mm lasting over 1 minute.
- Intervention times were prospectively recorded and correlated with ECG findings.
Main Results:
- 22% of patients (9/41) experienced ST depression during ERCP; 10% (4/41) had significant ST depression (>= -2 mm).
- Episodes of ST depression were associated with sedation (P < 0.01) and intubation.
- No association was found between specific therapeutic ERCP interventions (sphincterotomy, stent replacement) and ST depression.
Conclusions:
- Myocardial ischaemia occurs in approximately one-quarter of patients undergoing ERCP.
- Over half of patients experiencing ischaemia had no prior cardiac history or abnormal baseline ECG.
- Sedation and intubation are associated with myocardial ischaemia, while specific therapeutic interventions are not.
Background And Study Aims:
Myocardial ischaemia may occur during endoscopic retrograde cholangiopancreatography (ERCP) and this may predispose patients to ischaemic complications, although the incidence and risk factors for mycocardial ischaemia during ERCP have not been studied in detail. The aim of this study was to determine the incidence of myocardial ischaemia, as defined by ST changes on electrocardiography during ERCP, and whether or not any intervention predisposes to an increased risk of myocardial ischaemia.
Patients And Methods:
Consecutive patients undergoing ERCP at a single centre were included. Continuous Holter electrocardiograph recordings were carried out during ERCP. ST depression was defined as > 1 mm lasting for longer than 1 minute. The time of interventions during ERCP was recorded prospectively and related to the Holter recordings.
Results:
There were 41 patients in the study (14 men, 27 women; median age 66 years, range 21 - 88). Nine patients (22 %) experienced ST depression during the procedure, of whom four (10 %) showed significant ST depression (> or = - 2 mm). Of these, five had no previous cardiac history and normal electrocardiographic findings, three had no previous cardiac history but had abnormal electrocardiographic findings and one had a previous cardiac history and abnormal electrocardiographic results. ERCP interventions associated with the episodes of ST depression were administration of sedation ( n = 6, P < 0.01) endoscopic sphincterotomy ( n = 4), balloon trawl ( n = 1), basket trawl ( n = 3) and stent replacement ( n = 1) ( P > 0.05 for the rest). No cardiac complications occurred.
Conclusions:
Myocardial ischaemia occurred in approximately one-quarter of patients during ERCP, and over half of these had no previous cardiac history and normal baseline electrocardiography results. Myocardial ischaemia often accompanied the use of sedation and intubation of the patient, but specific therapeutic interventions were not associated with the onset of ischaemia.
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