Release of cardiac biochemical markers after percutaneous myocardial laser or sham procedures.
BACKGROUND
Percutaneous myocardial laser (PML) reduces symptoms in patients with intractable angina. PML leads to a certain loss of viable myocardium, we therefore assessed if troponin or cardiac markers release may explain the clinical effect, and furthermore assessed the markers release during percutaneous sham procedures.


METHODS
Eighty-two patients with chronic refractory angina were randomized to either percutaneous myocardial laser or a true sham procedure. Cardiac markers were assessed before the procedure, and (1/2), 2, 4, 6, and 10-12 h postprocedure.


RESULTS
Troponin I increased to median peak levels (range) of 4 (0.6-43) microg/L in the laser group vs. 1.5 (0.1-5.9) microg/L, p=0.001, and creatine kinase MB to 14 (6-357) microg/L vs. 11 (3-40) microg/L, p<0.05, within and between-group comparison, the rise of CK-MB occurred significantly earlier in the sham group, 3.8 vs. 2.5 h. A time-dependent between-group difference was only detected for troponin. 88% of sham and 100% of laser patients had marker levels above reference limits. There was no correlation between the number of laser/sham created channels, biomarker levels postprocedure, and changes in left ventricular ejection fraction or angina improvement during 12 months of follow-up.


CONCLUSIONS
The release of cardiac markers is not related to relief of angina after myocardial laser. The use of intracardiac catheters induces a considerable marker release, which is not caused by acute ischemia.
Salem
Mohammed
M
Department of Heart Disease, Haukeland University Hospital, N-5021 Bergen, Norway.
Rotevatn
Svein
S
Stavnes
Sindre
S
Brekke
Magne
M
Pettersen
Reidar
R
Kuiper
Karel
K
Ulvik
Rune
R
Nordrehaug
Jan Erik
JE
D000787:Angina Pectoris / Q000378:metabolism / Q000503:physiopathology / Q000601:surgery; D015906:Angioplasty, Balloon, Coronary / Q000379:methods; D017222:Angioplasty, Balloon, Laser-Assisted; D001219:Aspartate Aminotransferases / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D003324:Coronary Artery Disease / Q000378:metabolism / Q000503:physiopathology / Q000601:surgery; D052279:Creatine Kinase, MB Form / Q000097:blood* / Q000378:metabolism; D004311:Double-Blind Method; D005500:Follow-Up Studies; D006801:Humans; D009211:Myoglobin / Q000097:blood*; D011446:Prospective Studies; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D019210:Troponin I / Q000097:blood* / Q000378:metabolism
D015415:Biomarkers; D009211:Myoglobin; D019210:Troponin I; D001219:Aspartate Aminotransferases; D052279:Creatine Kinase, MB Form