title: Effect of intracoronary nicardipine on cardiac enzymes after elective percutaneous coronary intervention.
abstract: 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.
authors: Department of Cardiovascular Disease, Western Pennsylvania Hospital/Temple University Program, Pittsburgh, Pennsylvania 15224, USA. sandeeparora24@hotmail.com
authors: Sandeep
authors: S
authors: Arora
authors: Fadi
authors: F
authors: Alfayoumi
authors: Azimuddin Tareq
authors: AT
authors: Khawaja
authors: Aashish
authors: A
authors: Dua
authors: Venkatraman
authors: V
authors: Srinivasan
authors: Alan H
authors: AH
authors: Gradman
mesh_terms: 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*
chemical_list: D015415:Biomarkers; D002121:Calcium Channel Blockers; D019210:Troponin I; D009529:Nicardipine; D052279:Creatine Kinase, MB Form