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. 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.

Periprocedural myocardial injury during elective percutaneous coronary intervention: is it important and how can it be prevented?

“…Intracoronary nicardipine and verapamil have been successfully used in the treatment of no-reflow following PCI. Administration of intracoronary nicardipine failed to reduce the incidence of PMI in a prospective randomised trial 63. Also pretreatment with intragraft verapamil before PCI of saphenous vein grafts has been shown to reduce the rate of the no-reflow phenomenon but did not reduce PMI 64…”

Association of chronic kidney disease with periprocedural myocardial injury after elective stent implantation

“…[24] Retrospective studies have shown that intracoronary calcium antagonists nicardipine and verapamil have been successfully used in the treatment of no-reflow following PCI but have failed to reduce the incidence of PMI. [25] Schaefer and group of authors have shown, in a small number of patients, that intracoronary ACEIs during primary PCI suppress reperfusion-associated ventricular arrhythmias and improve coronary blood flow. [26] One recent study showed that chronic therapy with ACEI prior to elective PCI is associated with a 64% relative risk reduction of procedural MI.…”