Is Gastrointestinal Endoscopy Safe in the Setting of Recent Coronary Artery Reperfusion Therapy? A Pilot Study

Abstract

Purpose: To establish the safety of endoscopic procedures performed in patients who have undergone coronary artery reperfusion therapy via placement of a coronary artery stent or balloon angioplasty. Background: No specific guidelines exist for when and under what conditions it is safe to perform endoscopic procedures after a recent myocardial infarction(MI). Retrospective studies (Chin et al.) have addressed the role of endoscopy in the setting of recent MI. No studies have specifically addressed the safety of endoscopy in patients who have recently undergone reperfusion therapy. This population may have an additional risk of cardiopulmonary complications during or subsequent to endoscopy. Methods: A retrospective analysis of patients who underwent reperfusion therapy was performed at a tertiary care medical center in 2006. Subjects had undergone coronary artery reperfusion therapy via stent placement or balloon angioplasty after MI or unstable angina and within 30 days also underwent upper or lower gastrointestinal endoscopy. Indications, chronology, co-morbidities, anti-platelet drugs or anticoagulants, cardiac risk categories, type of procedure, findings, complications and their severity and mortality were recorded. Results: Of the 35 patients included in the study 57% (n = 20) were male, 43% (n = 15) were female. Average age was 77 (+/− 8) and BMI 26 (+/− 4). Indication included acute GI bleed (48%, n = 17), iron deficiency anemia (34% n = 12), abdominal pain (6% n = 2), dysphagia (6% n = 2), screening colonoscopy (3% n = 1) and PEG placement (3% n = 1). 14% (n = 5) had STEMI, 20% (n = 7) had NSTEMI and 66% (n = 23) had unstable angina. Procedures were done 7 (+/−7) days after stent placement. Comorbid conditions included hypertension (85% n = 30), dyslipidemia (80% n = 28), Arrhythmia (40% n = 14), chronic kidney disease (51% n = 18), CVA (8% n = 3). Patients were on ASA 325 mg, 28% (n = 10), ASA 81 mg, 31% (n = 12), clopidogrel 31% (n = 12), heparin or coumadin 20% (n = 7). Ejection fraction was normal 46% (n = 16), mildly (17 % n = 6), moderately (20 % n = 7), or severely (11% n = 4) reduced. Average length of procedure was 18 minutes (+/−10). NO post procedure bleeding was noted. One death was reported although it occurred greater than 30 days after endoscopy. No significant associations were found between the type of procedure, ejection fraction, anticoagulant/antiplatelet medication or length of time of procedure and bradycardia, tachycardia, hypoxia or mortality. Conclusions: Endoscopy after coronary artery stent placement or angioplasty is generally a safe procedure even in the post MI/unstable angina setting. Large scale studies are needed to further validate this conclusion.