Cardiopulmonary complications of ERCP in older patients.
BACKGROUND
Biochemical markers of ERCP-related myocardial injury have not previously been investigated.


OBJECTIVE
To evaluate ERCP-related cardiac troponin I (cTnI) release, myocardial ischemia, hemodynamic changes, and arterial hypoxemia in a series of consecutive patients according to age and to determine their relationship to preexisting cardiovascular risk factors (RF) and the development of post-ERCP pancreatitis.


METHODS
Prospective cohort study.


METHODS
Tertiary teaching hospital, Canberra, Australia.


METHODS
Data were collected on 130 consecutive ERCPs performed on 100 unselected patients (aged 18-93 years) by one endoscopist. Patients were divided into two groups: 65 years of age and older (group 1, n = 53; 27 women) and less than 65 years of age (group 2, n = 47; 33 women).


METHODS
ERCP.


METHODS
Cardiovascular RFs were identified, and electrocardiogram (ECG), cTnI, creatine kinase (CK), amylase, and lipase were measured before and 24 hours after ERCP. Oxygen saturation (SpO(2)), heart rate (HR), blood pressure (BP), and ECG were monitored continuously during each procedure.


RESULTS
New ECG changes (ischemia, arrhythmias) occurred in 24% of procedures in group 1 and in 9.3% in group 2 (p = 0.168), and episodic arterial hypoxemia (SpO(2) < 90%) in 16.2% (group 1) and 21.4% (group 2) (p = 0.596). A post-ERCP rise in cTnI levels was documented in 6 patients in the older group. Two of these patients died: one from acute myocardial infarction and one from undiagnosed ascending aortic aneurysm. A cTnI rise was not related to any comorbid conditions, total number of RFs, hemodynamic or ECG changes, or arterial desaturation. In patients with a new cTnI rise, the duration of ERCP was significantly longer (59.5 vs. 26.4 minutes, p = 0.026), being 30 minutes or longer in 5 of 6 patients. Post-ERCP pancreatitis was associated with desaturation (relative risk [RR] = 5.9; 95% confidence interval [CI] [1.2, 32.0], p = 0.027) and myocardial ischemia/injury (RR = 4.4; 95% CI [1.4, 7.8]; p = 0.009).


CONCLUSIONS
Although the majority of older patients tolerated ERCP well, in 8% of procedures, most of which were prolonged (>30 minutes), myocardial injury, as defined by the release of cTnI, occurred. Desaturation and myocardial ischemia/injury were associated with post-ERCP pancreatitis.
Fisher
Leon
L
Department of Gastroenterology, The Canberra Hospital, Woden, Canberra, ACT 2606, Australia.
Fisher
Alexander
A
Thomson
Andrew
A
D000368:Aged; D000369:Aged, 80 and over; D000758:Anesthesia; D001145:Arrhythmias, Cardiac / Q000209:etiology*; D001794:Blood Pressure; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D004562:Electrocardiography; D005260:Female; D006339:Heart Rate; D006801:Humans; D000860:Hypoxia / Q000209:etiology*; D008297:Male; D017202:Myocardial Ischemia / Q000209:etiology*; D010195:Pancreatitis / Q000209:etiology; D011446:Prospective Studies; D019210:Troponin I / Q000097:blood*
D019210:Troponin I