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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.
Insights
Percutaneous transluminal coronary angioplasty (PTCA) does not appear to cause significant myocardial injury. This study found no evidence of detectable heart muscle damage after uncomplicated PTCA procedures.
Area of Science:
- Cardiology
- Biochemistry
Background:
- Percutaneous transluminal coronary angioplasty (PTCA) is a common procedure.
- Assessing for subtle myocardial injury post-PTCA is crucial for patient outcomes.
Purpose of the Study:
- To investigate the incidence of subtle myocardial ischemic injury following PTCA.
- To evaluate the diagnostic utility of creatine kinase-MB (CK-MB) in detecting post-PTCA injury.
Main Methods:
- Prospective study of 28 patients undergoing PTCA.
- Serial ECGs and blood sampling for total CK and CK-MB at 4-hour intervals for 24 hours.
- Exclusion of patients requiring immediate cardiac surgery.
Main Results:
- Total CK elevations were minimal and often associated with premedication.
- Mean CK-MB levels remained within normal ranges throughout the 24-hour post-procedure period.
- Only one patient with a clear infarction showed elevated CK-MB.
Conclusions:
- Uncomplicated PTCA does not result in objectively detectable subtle myocardial injury.
- CK-MB is a reliable marker for assessing myocardial damage after PTCA.