The biochemical markers of ERCP-related myocardial injury have not previously been investigated.
In this study, doctors from Australia evaluated ERCP-related cardiac troponin I (cTnI) release, myocardial ischemia, hemodynamic changes, and arterial hypoxemia.
The team assessed 130 consecutive ERCPs performed by one endoscopist on 100 patients. The patients' age and pre-existing cardiovascular risk factors were recorded, as well as the development of post-ERCP pancreatitis.
Patients were divided into two groups: patients in group 1 were 65 years of age and older, while patients in group 2 were younger than 65.
Electrocardiogram (ECG), cTnI, creatine kinase, amylase, and lipase were measured both before and 24 hours after ERCP.
In addition, the team monitored oxygen saturation, heart rate, blood pressure, and ECG were monitored continuously during each procedure.
The doctors found that new ECG changes occurred in 24% of procedures in group 1 and in 9% in group 2.
|ECG changes occurred in 24% of procedures in group 1 and in 9% in group 2.|
There was a post-ERCP rise in cTnI levels in 6 patients in group 1.
The team found that a rise in cTnI levels was not related to any comorbid conditions, total number of risk factors, hemodynamic or ECG changes, or arterial desaturation.
However, in patients with a new cTnI rise, the duration of ERCP was significantly longer (59.5 vs 26.4 minutes).
In addition, the team determined that post-ERCP pancreatitis was associated with desaturation and myocardial ischemia/injury.
Dr Leon Fisher's team concluded, "Although the majority of older patients tolerated ERCP well, in 8% of procedures…myocardial injury… occurred".
"Desaturation and myocardial ischemia/injury were associated with post-ERCP pancreatitis".