Sedation-associated Complication in Post-percutaneous coronary intervention patients during Esophagogastroduodenoscopy with Midazolam

Aims We aimed to determine the surveillance performance of left ventricle ejection fraction (LVEF) by echocardiography to predict sedation-associated complications in endoscopy following percutaneous coronary intervention (PCI). Methods A single-center retrospective study was conducted at a tertiary hospital between January 2000 and December 2020. All patients who underwent PCI before Esophagogastroduodenoscopy (EGD) with titrated midazolam were enrolled. We defined transient hypotension (SBP <90 mmHg or at least 20 mmHg less than baseline) and oxygen desaturation (SpO2 <90% on room air or <95% on 2 L/min of oxygen) [ 1 ]. Results A total of 450 post-PCI patients underwent EGD with midazolam, and all enrolled patients had echocardiography within 2 years before endoscopy. Among them, 16 patients were confirmed as having hypotension during EGD with sedation. The AUC of the ROC curve for developing hypotension during endoscopy according to the LVEF was 0.727 (95% CI, 0.67–0.78); the calculated optimal cut-off value was 55%. The sensitivity and specificity of LVEF were 92.9% and 55.1%, respectively. The figure shows the association between the risk of hypotension during endoscopy and continuous measures of LVEF using the restricted cubic spline curve. A nonlinear association between LVEF and risk of hypotension was noted, and the negative slope was steep (between 0 and 55%), reaching a plateau above 56% ([ Fig. 1 ]). Fig. 1 Conclusions LVEF measured before endoscopy was significantly associated with hypotension during sedation endoscopy in post-PCI patients. Publication History Article published online: 14 April 2023 © 2023. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany