Paucity of subtle myocardial injury after angioplasty delineated with MB CK

Abstract

To determine the extent to which PTCA elicits subtle myocardial ischemic injury, 28 patients were studied prospectively. The presence of myocardial injury was assessed by analysis of frequent (q4 hours) serial samples of MB CK, a sensitive and specific marker of myocardial injury. Immediately prior to angioplasty, baseline 12-lead ECGs and blood samples for evaluation of total CK and MB CK were obtained. Additional ECGs were obtained immediately after the procedure and on the following morning, and serial samples for total and MB CK were obtained at 4-hour intervals for 24 hours. Patients requiring cardiac surgery within 24 hours after PTCA were excluded. Samples (n = 203) were assayed by the glass bead method. Total CK rose by more than 20 IU/L in only five patients, four of whom had received intramuscular premedication. Mean MB CK was 3.4 +/- 6.1 IU/L at 12 hours and 4.1 +/- 4.7 IU/L at 24 hours compared to 3.1 +/- 1.7 IU/L prior to angioplasty. Only one patient with obvious infarction had a value for MB CK above the normal range. Thus, uncomplicated PTCA is not accompanied by objectively detectable subtle myocardial injury.

Efficacy of electroacupuncture pretreatment for myocardial injury in patients undergoing percutaneous coronary intervention: A randomized clinical trial with a 2-year follow-up

“…Increased serum cardiac enzymes, including cardiac troponin I (cTnI), occur in more than 25% of post-PCI patients [3,4]. A wealth of evidence supports the correlation of extensive cardiac enzyme release after PCI with cardiac injury [5,6] and delayed mortality [7,8]. Statins [9], beta-blockers [10], cyclosporine [11] and trimetazidine [12] have been reported to limit the rate and extent of PCI-associated myocardial infarction (MI type 4a) [13].…”

Increase in serum cardiac myosin light chain I associated with elective percutaneous transluminal coronary angioplasty in patients with ischemic heart disease

“…It has therefore been reported that PTCA does not cause myocardial injury. 6 However, in their study with Mb, Pauletto et al7 noted the release of Mb as well as CK-MB, suggesting myocardial injury at the intramyocardial Mb structural level. Such divergence in the findings regarding the release of intramyocardial substances may be attributed to the following reasons: the changes in CK, CK-MB and Mb after PTCA are slight, if any; and the release reaches a peak in a very short time (4-8 hours for CK and 2-4 hours for Mb).…”

“…Changes in CK, CK-MB (MB isozyme of CK) and Mb associated with elective PTCA have been reported, 6-' but to date, no studies on changes in MLCI have been published. To investigate PTCA-associated myocardial damage, 6,7 we studied changes in serum MLCI following elective PTCA and their possible pathophysiological significance.…”

Troponin T In The Coronary Sinus And Percutaneous Transluminal Coronary Angioplasty Related Myocardial Injury

“…Percutaneous transluminal coronary angioplasty (PTCA) is a conventional technique for the dilation of coronary artery stenosis. Although PTCA is usually safe, some recent reports have demonstrated that a mild elevation of cardiac enzyme levels after PTCA is fairly common (15–26%) 1–4 . However, the markers used in these studies were not specific for cardiac muscle.…”