877 Impact of Prior Myocardial Infarction or Revascularization on Outcomes of Adult Patients Undergoing Endoscopic Retrograde Cholangiopancreatography (ERCP): An 8-year Nationwide Inpatient Outlook

Abstract

INTRODUCTION: Considering its inflammatory potential Endoscopic retrograde cholangiopancreatography (ERCP) can prompt myocardial infarction in patients with preexisting coronary artery disease (CAD). However, the data regarding the impact of previous MI/revascularization procedures are non-existent. We aimed to compare the outcomes of adult patients undergoing ERCP with vs. without any such prior history. METHODS: Using the ICD-9 CM codes in the National Inpatient Sample (2007 -2014) we identified adult patients undergoing ERCP who had a prior history of MI, PCI or CABG. Primary endpoints- inpatient mortality and post-ERCP complications. Secondary endpoints- discharge disposition, mean length of stay and total hospital charges. SPSS version 22 (IBM Corp, NY, USA) was used for all analyses. Categorical and continuous variables were compared using the Chi-square test and Student’s t-test, respectively. A two-tailed P value ≤ 0.05 was set as the cutoff for the statistical significance. RESULTS: Of total 1,374,773 ERCP procedures performed between 2007 to 2014, 120,418 (8.8%) were performed in patients who had a prior history of MI, PCI or CABG (study cohort) and the rest were considered the control cohort. The study-cohort had older (mean age 74y vs. 58y) population and more males (63.9% vs. 37.6%), who were admitted non-electively (88.1% vs. 87.3%) as compared to the control cohort (P < 0.001) Figure 1. compares baseline characteristics between both cohorts. There is an increasing trend of performing ERCP in study group between 2007 to 2014 (7.5% to 9.5%; P trend = 0.022) with a decrease in inpatient mortality from 1.8 to 1.4% (Figure 1). All-cause inpatient mortality was also higher (1.7% vs. 1.5%, P < 0.001) in the study cohort (Figure 1). Post-ERCP cardiopulmonary complications, sepsis, and haemorrhage were all higher in the study group (P < 0.001) (Table 2). However, post-ERCP pancreatitis (14.1% vs. 15.4%, P < 0.001) was lower in the study group without any difference in cholecystitis (0.4% vs. 0.4%, P = 0.180). The mean length of stay (6.8 days vs 6.6 days) was marginally higher in the study cohort without any difference in the hospitalization charges. CONCLUSION: In this nationwide retrospective study, we determined higher inpatient mortality and cardiopulmonary complications, sepsis, and haemorrhage in adult patients undergoing ERCP with a prior history of MI, PCI or CABG. Future prospective studies are warranted to delineate the impact of prior infarction or revascularization on the outcomes of ERCP.