Effect of intracoronary nicardipine on cardiac enzymes after elective percutaneous coronary intervention.
BACKGROUND
Elevation in cardiac enzymes after percutaneous coronary intervention (PCI) is common and is associated with adverse clinical outcomes.


OBJECTIVE
Administration of intracoronary nicardipine--a calcium channel blocker will reduce cardiac enzyme levels in patients undergoing elective PCI.


METHODS
In a single center, prospective, double-blind placebo-controlled trial, 193 patients undergoing elective PCI (with or without stenting) for chronic stable angina and/or an abnormal stress test were randomized to receive 200 mcg of intracoronary nicardipine (n = 93) or saline solution (n = 100) prior to intervention. Cardiac enzyme levels were measured immediately and at 8 and 16 hours after the procedure. Major adverse clinical events (MACE) were assessed at 30 days and at 6 months.


RESULTS
Incidence of periprocedural myonecrosis defined as elevation of troponin I levels > 1x the upper limit of normal was similar in both groups (placebo 15.4% vs drug 10.6%; P = 0.47). There was no significant difference in peak troponin I levels after PCI between the 2 groups (placebo 0.58 ng/mL +/- 1.08 ng/mL vs drug 0.97 ng/mL +/- 3.6 ng/mL; P = 0.35). Major adverse clinical events at 6 months were infrequent and not statistically different in the 2 groups (placebo 3.4% vs drug 1.2%; P = 0.52). Multivariate analysis revealed that pretreatment with nicardipine was not associated with reduction in the incidence of troponin I elevation (odds ratio [OR]: 0.54; 95% confidence interval [CI]: 0.18-1.6; P = 0.28).


CONCLUSIONS
In low-risk patients undergoing elective PCI, intracoronary nicardipine administration did not produce a significant cardioprotective effect in reducing postprocedural cardiac enzymes leakage.
Arora
Sandeep
S
Department of Cardiovascular Disease, Western Pennsylvania Hospital/Temple University Program, Pittsburgh, Pennsylvania 15224, USA. sandeeparora24@hotmail.com
Alfayoumi
Fadi
F
Khawaja
Azimuddin Tareq
AT
Dua
Aashish
A
Srinivasan
Venkatraman
V
Gradman
Alan H
AH
D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000295:instrumentation; D015415:Biomarkers / Q000097:blood; D002121:Calcium Channel Blockers / Q000008:administration & dosage*; D003324:Coronary Artery Disease / Q000188:drug therapy / Q000628:therapy*; D052279:Creatine Kinase, MB Form / Q000097:blood*; D004311:Double-Blind Method; D006331:Heart Diseases / Q000201:enzymology / Q000473:pathology / Q000517:prevention & control*; D006801:Humans; D007269:Injections, Intra-Arterial; D016015:Logistic Models; D009206:Myocardium / Q000201:enzymology* / Q000473:pathology; D009336:Necrosis; D009529:Nicardipine / Q000008:administration & dosage*; D016017:Odds Ratio; D011446:Prospective Studies; D018570:Risk Assessment; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D019210:Troponin I / Q000097:blood*
D015415:Biomarkers; D002121:Calcium Channel Blockers; D019210:Troponin I; D009529:Nicardipine; D052279:Creatine Kinase, MB Form