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Periprocedural myocardial ischemia in patients with severe symptomatic coronary artery disease undergoing endoscopy:
J G Lee1, M W Krucoff, S R Brazer
1Division of Gastroenterology, Duke University Medical Center, Durham, North Carolina, USA.
Insights
Periprocedural myocardial ischemia occurred in 16% of patients with severe coronary artery disease undergoing gastrointestinal endoscopy. Women showed a higher risk of ischemia during these procedures.
Area of Science:
- Cardiology
- Gastroenterology
- Medical Procedures
Background:
- Gastrointestinal endoscopy is common in patients with coronary artery disease.
- Periprocedural myocardial ischemia is a potential complication.
- Risk factors and prevalence in severe coronary artery disease (CAD) are not well-defined.
Purpose of the Study:
- To determine the prevalence of periprocedural myocardial ischemia.
- To identify risk factors for ischemia during gastrointestinal endoscopy.
- To assess safety in patients with severe symptomatic CAD.
Main Methods:
- Prospective observational study.
- Continuous 12-lead digital ECG monitoring before, during, and after endoscopy.
- Defined myocardial ischemia as specific ST segment changes.
Main Results:
- 16% of patients (8/49) experienced periprocedural ischemia.
- Ischemia occurred pre-, intra-, and post-procedure.
- Women had a higher incidence of ischemia (31% vs. 11% in men).
Conclusions:
- Myocardial ischemia is detected in 16% of high-risk patients undergoing endoscopy.
- Endoscopy appears safe for hemodynamically stable patients with recent MI or unstable angina.
- Women may be at increased risk for periprocedural ischemia.
Purpose:
To determine the prevalence of and risk factors for periprocedural myocardial ischemia associated with gastrointestinal endoscopy in patients with severe symptomatic coronary artery disease.
Patients And Methods:
In this prospective observational study, myocardial ischemia (ST segment change > 100 microV in any 2 leads or > 200 microV in any 1 lead, lasting > 60 seconds) was assessed using a continuous 12-lead digital electrocardiographic monitor before, during, and after gastrointestinal endoscopy.
Results:
Between June 1992 and May 1993, 1,084 esophagogastroduodenoscopies and 588 colonoscopies were performed during 1,438 consecutive endoscopies on patients admitted to a university hospital. Seventy (18%) of 252 patients with prior angiography had significant coronary artery disease. Fifty-two (74%) were successfully enrolled, and satisfactory electrocardiographic recordings were obtained from 49 (median age 65 years, interquartile range 58 to 74). Thirty-six were men, 12 had myocardial infarctions within the 6 weeks (median 12.5 days, interquartile range 8 to 18), and 25 had unstable angina. The coronary artery disease involved 1 vessel in 14 subjects, 2 vessels in 21, and 3 vessels in 14. Nineteen episodes of ischemia (4 pre-, 6 intra-, 9 postprocedure) were detected in 8 patients (16%; 95% confidence interval, 6% to 26%) during the recording period (median duration 322 min, interquartile range 227 to 429). One patient became symptomatic with a myocardial infarction. Multivariable logistic regression showed that women experienced more periprocedural ischemia compared to men (31% versus 11%; P = 0.058).
Conclusions:
Myocardial ischemia occurs during the periprocedural period in 16% of hospitalized patients with severe coronary artery disease undergoing gastrointestinal endoscopy. Endoscopy is safe in hemodynamically stable patients with recent myocardial infarction and/or unstable angina. Women appear to be at greater risk for periprocedural ischemia associated with endoscopy.
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