Skip to main content
NCBI home page
Clinical Cardiology logoLink to Clinical Cardiology
. 2009 Jun 30;32(6):315–320. doi: 10.1002/clc.20580

Effect of Intracoronary Nicardipine on Cardiac Enzymes After Elective Percutaneous Coronary Intervention

Sandeep Arora 1,✉, Fadi Alfayoumi 1, Azimuddin Tareq Khawaja 1, Aashish Dua 1, Venkatraman Srinivasan 1, Alan H Gradman 1
PMCID: PMC6653674  PMID: 19569065

Abstract

Background

Elevation in cardiac enzymes after percutaneous coronary intervention (PCI) is common and is associated with adverse clinical outcomes.

Hypothesis

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 > 1× 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. Copyright © 2009 Wiley Periodicals, Inc.

Full Text

The Full Text of this article is available as a PDF (209.6 KB).

References

  • 1. Saucedo JF, Mehran R, Dangas G, et al. Long‐term clinical events following creatine kinase—myocardial band isoenzyme elevation after successful coronary stenting. J Am Coll Cardiol 2000; 35(5): 1134–1141. [DOI] [PubMed] [Google Scholar]
  • 2. Okmen E, Kasikcioglu H, Sanli A, Uyarel H, Cam N. Correlations between cardiac troponin I, cardiac troponin T, and creatine phosphokinase MB elevation following successful percutaneous coronary intervention and prognostic value of each marker. J Invasive Cardiol 2005; 17(2): 63–67. [PubMed] [Google Scholar]
  • 3. Saadeddin SM, Habbab MA, Sobki SH, Ferns GA. Minor myocardial injury after elective uncomplicated successful PTCA with or without stenting: detection by cardiac troponins. Catheter Cardiovasc Interv 2001; 53(2): 188–192. [DOI] [PubMed] [Google Scholar]
  • 4. Prasad A, Singh M, Lerman A, Lennon RJ, Holmes DR Jr, Rihal CS. Isolated elevation in troponin T after percutaneous coronary intervention is associated with higher long‐term mortality. J Am Coll Cardiol 2006; 48(9): 1765–1770. [DOI] [PubMed] [Google Scholar]
  • 5. Nageh T, Sherwood RA, Harris BM, Byrne JA, Thomas MR. Cardiac troponin T and I and creatine kinase‐MB as markers of myocardial injury and predictors of outcome following percutaneous coronary intervention. Int J Cardiol 2003; 92(2–3): 285–293. [DOI] [PubMed] [Google Scholar]
  • 6. Pasceri V, Patti G, Nusca A, Pristipino C, Richichi G, Sciascio GD. Randomized trial of atorvastatin for reduction of myocardial damage during coronary intervention: results from the ARMYDA (Atorvastatin for Reduction of MYocardial Damage during Angioplasty) study. Circulation 2004; 110(6): 674–678. [DOI] [PubMed] [Google Scholar]
  • 7. Bonz AW, Lengenfelder B, Strotmann J, et al. Effect of additional temporary glycoprotein IIb/IIIa receptor inhibition on troponin release in elective percutaneous coronary interventions after pretreatment with aspirin and clopidogrel (TOPSTAR trial). J Am Coll Cardiol 2002; 40(4): 662–668. [DOI] [PubMed] [Google Scholar]
  • 8. Lee CH, Low A, Tai BC, et al. Pretreatment with intracoronary adenosine reduces the incidence of myonecrosis after non‐urgent percutaneous coronary intervention: a prospective randomized study. Eur Heart J 2007; 28(1): 19–25. [DOI] [PubMed] [Google Scholar]
  • 9. Kurz DJ, Naegeli B, Bertel O. A double‐blind, randomized study of the effect of immediate intravenous nitroglycerin on the incidence of postprocedural chest pain and minor myocardial necrosis after elective coronary stenting. Am Heart J. 2000; 139(1Pt1): 35–43. [DOI] [PubMed] [Google Scholar]
  • 10. Murakami M, Iwasaki K, Kusachi S, et al. Nicorandil reduces the incidence of minor cardiac marker elevation after coronary stenting. Int J Cardiol 2006; 107(1): 48–53. [DOI] [PubMed] [Google Scholar]
  • 11. Jang YH, Kim JM. Nicardipine augments local myocardial perfusion after coronary artery reperfusion in dogs. J Korean Med Sci 2003; 18(1): 23–26. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 12. Fugit MD, Rubal BJ, Donovan DJ. Effects of intracoronary nicardipine, diltiazem and verapamil on coronary blood flow. J Invasive Cardiol 2000; 12(2): 80–85. [PubMed] [Google Scholar]
  • 13. Huang RI, Patel P, Walinsky P, et al. Efficacy of intracoronary nicardipine in the treatment of no‐reflow during percutaneous coronary intervention. Catheter Cardiovasc Interv 2006; 68(5): 671–676. [DOI] [PubMed] [Google Scholar]
  • 14. Harris BM, Nageh T, Marsden JT, Thomas MR, Sherwood RA. Comparison of cardiac troponin‐T and I and CK‐MB for the detection of minor myocardial damage during interventional cardiac procedures. Ann Clin Biochem 2000; 37: 764–769. [DOI] [PubMed] [Google Scholar]
  • 15. Patti G, Colonna G, Pasceri V, Pepe LL, Montinaro A, Sciascio GD. Randomized trial of high loading dose of clopidogrel for reduction of periprocedural myocardial infarctionin patients undergoing coronary intervention. Circulation 2005; 111: 2099–2106. [DOI] [PubMed] [Google Scholar]
  • 16. Izgi A, Tanalp AC, Kirma C, et al. Predictors and prognostic significance of troponin I release following elective coronary angioplasty. J Int Med Res 2006; 34(6): 612–623. [DOI] [PubMed] [Google Scholar]
  • 17. Ricciardi MJ, Davidson CJ, Gubernikoff G, et al. Troponin‐I elevation and cardiac events after percutaneous coronary intervention. Am Heart J 2003; 145: 522–528. [DOI] [PubMed] [Google Scholar]
  • 18. Selvanayagam JB, Porto I, Channon K, et al. Troponin elevation after percutaneous coronary intervention directly represents the extent of irreversible myocardial injury: insights from cardiovascular magnetic resonance imaging. Circulation 2005; 111(8): 1027–1032. [DOI] [PubMed] [Google Scholar]
  • 19. Akkerhuis KM, Alexander JH, Tardiff BE, et al. Minor myocardial damage and prognosis: are spontaneous and percutaneous coronary intervention‐related events different? Circulation 2002; 105(5): 554–556. [DOI] [PubMed] [Google Scholar]
  • 20. Steinhubl SR, Berger PB, Mann JT III, et al. Clopidogrel for the reduction of events during observation; early and sustained dual anti‐platelet therapy following percutaneous coronary intervention: a randomized controlled trial. JAMA 2002; 288: 2411–2420. [DOI] [PubMed] [Google Scholar]
  • 21. Thomas GR, DiFabio JM, Gori T, Parker JD. Once daily therapy with isosorbide‐5‐mononitrate causes endothelial dysfunction in humans. J Am Coll Cardiol 2007; 49: 1289–1295. [DOI] [PubMed] [Google Scholar]
  • 22. Hink U, Daiber A, Kayhan N, et al. Oxidative inhibition of the mitochondrial aldehyde dehydrogenase promotes nitroglycerin tolerance in human blood vessels. J Am Coll Cardiol 2007; 50: 2226–2232. [DOI] [PubMed] [Google Scholar]
  • 23. Fischell TA, Subraya RG, Ashraf K, Perry B, Haller S. “Pharmacological” distal protection using prophylactic intragraft nicardipine to prevent no‐reflow and non‐Q‐wave myocardial infarction during elective saphenous vein graft intervention. J Invasive Cardiol 2007; 19(2): 58–62. [PubMed] [Google Scholar]
  • 24. Murakami M, Iwasaki K, Kusachi S, et al. Nicorandil reduces the incidence of minor cardiac marker elevation after coronary stenting. Int J Cardiol 2007; 107: 48–53. [DOI] [PubMed] [Google Scholar]
  • 25. Vijayalakshmi K, Whittaker VJ, Kunadian B, et al. Prospective randomized controlled trial to study the effect of intracoronary injection of verapamil and adenosine on coronary blood flow during percutaneous coronary intervention in patients with acute coronary syndrome. Heart 2006; 92: 1278–1284. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 26. Lee CH, Low A, Tai BC, et al. Pretreatment with intracoronary adenosine reduces the incidence of myonecrosis after non‐urgent percutaneous coronary intervention: a prospective randomized study. Eur Heart J 2007; 28: 19–25. [DOI] [PubMed] [Google Scholar]

Articles from Clinical Cardiology are provided here courtesy of Wiley

RESOURCES