Document Detail

Differential release of cardiac enzymes after percutaneous coronary intervention.
MedLine Citation:
PMID:  15812827     Owner:  NLM     Status:  MEDLINE    
We hypothesized that using calcium channel blockers (CCBs) that dilate microvasculature during percutaneous coronary intervention (PCI) would result in lower postprocedural creatine phosphokinase (CPK). PCI can be complicated by elevated CPK that has been associated with impaired microvascular perfusion. Nitroglycerin (NTG), the conventional PCI vasodilator, dilates epicardial arteries but does not affect the microvasculature. We hypothesized that using CCBs that dilate the microvasculature would result in lower postprocedural CPK values. Patients (n = 816) without evidence of acute myonecrosis undergoing PCI were divided into two groups based on whether they received intracoronary NTG or CCB during PCI. Postprocedural CPK values were compared using a repeated-measures ANOVA and a random coefficient model. By repeated-measures analysis, the NTG group had CPK values of 88%, 83%, and 89% of the CCB group's CPK values at < 8, 8-14, and > 14 hr after PCI (P = 0.0080, 0.0002, and 0.0244), respectively. In a random coefficient model, the NTG group had CPK values 84%, 84%, and 89% of the CCB group's mean CPK values at 6, 12, and 18 hr after PCI (P = 0.0003, 0.0006, and 0.0403), respectively. Peak CPK values occurred earlier with CCB, although the maximal CPK was similar in both groups. Intracoronary CCB use is associated with an accelerated release of CPK after PCI compared with NTG. This is consistent with more efficient relief of microvascular obstruction with CCB. It suggests that myonecrosis may originate with vascular trauma at the time of PCI and its enzymatic expression is modifiable with different vasodilators.
Mark A Matthews; Susan J Kunselman; Joseph A Gascho; Ian C Gilchrist
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions     Volume:  65     ISSN:  1522-1946     ISO Abbreviation:  Catheter Cardiovasc Interv     Publication Date:  2005 May 
Date Detail:
Created Date:  2005-04-28     Completed Date:  2005-09-15     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  100884139     Medline TA:  Catheter Cardiovasc Interv     Country:  United States    
Other Details:
Languages:  eng     Pagination:  19-24     Citation Subset:  IM    
Copyright Information:
(c) 2005 Wiley-Liss, Inc.
Department of Internal Medicine, College of Medicine, Pennsylvania State University, 500 University Drive, Hershey, PA 17033, USA.
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MeSH Terms
Angioplasty, Transluminal, Percutaneous Coronary*
Biological Markers / blood
Calcium Channel Blockers / administration & dosage,  therapeutic use
Coronary Vessels / drug effects,  physiopathology
Creatine Kinase / blood*
Follow-Up Studies
Injections, Intra-Arterial
Middle Aged
Myocardial Ischemia / enzymology,  physiopathology,  therapy*
Myocardium / enzymology*
Nitroglycerin / administration & dosage,  therapeutic use
Prospective Studies
Treatment Outcome
Vasodilation / drug effects
Vasodilator Agents / administration & dosage,  therapeutic use
Reg. No./Substance:
0/Biological Markers; 0/Calcium Channel Blockers; 0/Vasodilator Agents; 55-63-0/Nitroglycerin; EC Kinase

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