Effect of intracoronary nicardipine on cardiac enzymes after elective percutaneous coronary intervention
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Published on: April 4, 2022
Sandeep Arora1, Fadi Alfayoumi, Azimuddin Tareq Khawaja
1Department of Cardiovascular Disease, Western Pennsylvania Hospital/Temple University Program, Pittsburgh, Pennsylvania 15224, USA. sandeeparora24@hotmail.com
Insights
Intracoronary nicardipine did not reduce cardiac enzyme levels after percutaneous coronary intervention (PCI) in low-risk patients. This study found no significant cardioprotective effect, indicating nicardipine is not beneficial for reducing post-PCI enzyme leakage.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pharmacology
Background:
- Elevated cardiac enzymes post-percutaneous coronary intervention (PCI) are common and linked to adverse outcomes.
- Investigating interventions to mitigate myocardial injury during PCI is crucial for improving patient prognosis.
Purpose of the Study:
- To evaluate the efficacy of intracoronary nicardipine, a calcium channel blocker, in reducing cardiac enzyme levels after elective PCI.
- To determine if nicardipine administration offers a cardioprotective effect by preventing postprocedural myonecrosis.
Main Methods:
- A prospective, double-blind, placebo-controlled trial involving 193 patients undergoing elective PCI.
- Patients were randomized to receive either intracoronary nicardipine (200 mcg) or a saline placebo prior to the procedure.
- Cardiac enzyme levels (troponin I) and major adverse clinical events (MACE) were monitored post-PCI.
Main Results:
- No significant difference in the incidence of periprocedural myonecrosis (troponin I elevation) between the nicardipine and placebo groups (10.6% vs. 15.4%, P=0.47).
- Peak troponin I levels and 6-month MACE rates were similar in both groups, with no statistically significant reduction observed with nicardipine.
- Multivariate analysis confirmed that nicardipine pretreatment did not reduce the incidence of troponin I elevation (OR: 0.54; P=0.28).
Conclusions:
- Intracoronary nicardipine administration did not demonstrate a significant cardioprotective effect in low-risk patients undergoing elective PCI.
- The study concludes that nicardipine is not effective in reducing postprocedural cardiac enzyme leakage in this patient population.
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 > 1x 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.
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