Key result
Elevated cardiac enzymes after percutaneous coronary intervention were associated with worse clinical outcomes, including a 2% in-hospital mortality rate compared to 0% in patients with normal enzymes.
Why the study?
Does raised cardiac enzymes after PCI increase mortality and MACE in patients with ischemic heart disease undergoing PCI?
Observational (n=200)
No
Does raised cardiac enzymes after PCI increase mortality and MACE in patients with ischemic heart disease undergoing PCI?
Elevated CK-MB after PCI is associated with worse 30-day clinical outcomes, including increased rates of NSTEMI and repeat target lesion revascularization.
Answers are grounded in this paper and cite their sources.
Should not yet change PCI management; leaves open whether routine enzyme monitoring improves outcomes in ischemic heart disease.
Introduction: The incidence of creatine kinase-myocardial band (CK-MB)isoenzyme elevation after percutaneous coronary intervention (PCI) ranges from 11% to 35%,including low-level elevations with no associated signs or symptoms as well as large non–Qwaveand Q-wave myocardial infarction. Whereas the deleterious effect on survival of largeperiprocedural myocardial infarctions have been well documented. Large periproceduralmyocardial infarctions, such as those caused by occlusion of a large side branch, flow-limitingdissection, or distal embolization of a large thrombus, would be undesirable and associatedwith worse subsequent cardiac outcomes. Objectives: To correlate the clinical outcomeafter PCI with cardiac biochemical markers. Study Design: Observational follow-up study.Setting: Faisalabad Institute of Cardiology, Faisalabad. Duration of Study with Dates: Sixmonths (February, 2014 to August, 2014). Patients and Methods: Two hundred patients withsymptoms of myocardial ischemia proceeding for percutaneous coronary intervention wereenrolled in the study. After taking history and clinical examination, the patients divided into twogroups: group I and group II. Group I comprised one hundred and fifty patients having normalcardiac enzymes and group II comprised fifty patients having raised cardiac enzymes. Results:Out of 50 patients with raised cardiac enzymes 42 (84%) were males and 8 (16%) were females,multi vessel coronary disease (58%), multi vessel PCI (54.3%). Periprocedural complicationsdissection (6%), side branch compromise (14%), slow flow (10%), no reflow (2%), sub-acutestent thrombosis (4%) occurred in group II as compared to slow flow (1.4%) and sub-acutestent thrombosis (0.7%) in group I. In hospital mortality (2%) in group II while no mortality ingroup I. On thirty day follow up 32% patients became symptomatic among which 6% developednon ST elevation MI in group II while only 1.4% patients had symptoms of angina in group I.6% patients needed repeat target lesion revascularization in group II and only 0.7% in groupI. Conclusion: Patients with raised cardiac enzymes had worse clinical outcome in terms ofmortality, myocardial infarction and repeat target lesion revascularization than normal cardiacenzymes.
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Asghar et al. (2017) conducted an observational in Ischemic heart disease undergoing percutaneous coronary intervention (n=200). Raised cardiac enzymes post-PCI vs. Normal cardiac enzymes post-PCI was evaluated on In-hospital or 30 days mortality. Elevated cardiac enzymes after percutaneous coronary intervention were associated with worse clinical outcomes, including a 2% in-hospital mortality rate compared to 0% in patients with normal enzymes.
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