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Significance of serum enzyme changes after cardiac catheterization and selective coronary arteriography
Insights
Cardiac catheterization can cause mild myocardial damage, indicated by increased serum creatine kinase (CK) levels. This damage is less severe than acute myocardial infarction and is linked to the coronary arteriography procedure itself.
Area of Science:
- Cardiology
- Clinical enzymology
- Diagnostic imaging
Background:
- Ischaemic heart disease necessitates diagnostic procedures like cardiac catheterization.
- Assessing potential iatrogenic effects of cardiac procedures on cardiac enzymes is crucial.
Purpose of the Study:
- To evaluate serum enzyme changes after cardiac catheterization and angiocardiography.
- To determine if selective coronary arteriography contributes to myocardial damage.
- To compare procedure-induced enzyme elevation with that of acute myocardial infarction.
Main Methods:
- Serum creatine kinase (CK), aspartate transaminase (AST), lactic dehydrogenase (LD), and alpha-hydroxybutyric dehydrogenase (HBD) were measured in 51 patients with ischaemic heart disease before and up to 36 hours after cardiac catheterization and angiocardiography.
- Patients were categorized into groups based on the presence and severity of coronary narrowing and whether selective coronary arteriography was performed.
- Enzyme levels were compared between groups and with a control group of patients with acute myocardial infarction.
Main Results:
- Mean serum CK levels increased significantly after cardiac catheterization and angiocardiography in patients who underwent selective coronary arteriography.
- Serum AST, LD, and HBD levels showed minimal abnormal increases.
- Patients without significant coronary narrowing (group 1) exhibited higher CK elevations than those with significant narrowing (group 2).
- CK elevations were substantially lower than those observed in patients with acute myocardial infarction.
- Patients without selective coronary arteriography (group 3) showed no significant enzyme increase.
Conclusions:
- Selective coronary arteriography, not just cardiac catheterization, appears to cause minor myocardial damage, evidenced by elevated serum CK.
- The observed myocardial damage is distinct from, and less severe than, that associated with acute myocardial infarction.
- The degree of CK elevation correlates with the extent of coronary narrowing, suggesting a procedural mechanism.
Abstract:
The serum creatine kinase (CK), aspartate transaminase (AST), lactic dehydrogenase (LD) and alpha-hydroxybutyric dehydrogenase (HBD) were determined before and 3, 6, 18, and 36 hours after cardiac catheterization and angiocardiography in 56 consecutive patients with ischaemic heart disease. Five of these patients whose serum enzyme levels were higher than normal before the procedure were excluded from the study. Forty-one of the remaining 51 patients had left ventriculography and also selective coronary arteriography. In these 41 patients (groups 1 and 2--see below), the mean serum CK levels increased after the procedure to exceed the upper limit of normal at every study interval. The mean serum AST, LD, and HBD levels generally remained within the normal range at all study intervals, though serum AST increased abnormally in 9 of the 41 patients (22%) and serum LD and HBD each increased above the normal limit in 2 of 41 patients (4.9%). In 24 patients (group 1) whose coronary arteriograms showed insignificant coronary narrowing (less than 75%) in any of the three major coronary arteries, the increase in serum CK was significantly higher than in 17 patients (group 2) with greater than 75% narrowings in at least one of the three major coronary arteries. However, the degree of serum CK elevation observed during the postangiographic period was much lower than that in another group of 30 consecutive patients with acute myocardial infarction. In 10 patients (group 3) who had the same procedure as groups 1 and 2 except without the selective coronary arteriography, the serum enzyme levels showed no noticeable increase after the procedure. The difference in postangiographic serum CK elevation between patients with and without selective coronary arteriography and the difference between group 1 (without significant coronory narrowing) and group 2 (with significant narrowing) strongly suggest that the raised serum CK levels represent some form of myocardial damage caused by the coronary arteriography, which, however, is different at least in degree from that of acute myocardial infarction.