Silent Myocardial Ischaemia during Endoscopic Retrograde Cholangiopancreatography

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 (≥ - 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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