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Am J Med. 1995 Sep;99(3):270-5.

Periprocedural myocardial ischemia in patients with severe symptomatic coronary artery disease undergoing endoscopy: prevalence and risk factors.

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1
Division of Gastroenterology, Duke University Medical Center, Durham, North Carolina, USA.

Abstract

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.

PMID:
7653487
[Indexed for MEDLINE]

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