NEW YORK (Reuters Health) – Intracoronary nicardipine before elective percutaneous coronary intervention (PCI) does not reduce post-treatment cardiac enzyme leakage in low-risk patients, new research shows.

Prior research has shown that cardiac enzyme elevation is a common finding after PCI and that it associated with adverse outcomes, Dr. Sandeep Arora, from North Western Pennsylvania Hospital, Pittsburgh, and colleagues explain. Whether treatment with the calcium channel blocker nicardipine might help reduce enzyme levels was unclear.

The current study, reported in the June issue of Clinical Cardiology, featured 193 patients who were randomized to receive intracoronary nicardipine or saline prior to undergoing elective PCI for chronic stable angina, an abnormal stress test, or both. Cardiac enzyme levels were measured immediately after treatment and again at 8 and 16 hours.

The percentage of nicardipine-treated patients with periprocedural myonecrosis (troponin I levels >1x the upper limit of normal) was 10.6%, lower but not significantly different from the 15.4% percentage in the placebo group. Peak troponin I levels also did not differ significantly between the groups.

Multivariate analysis confirmed that nicardipine use was not significantly associated with a drop in troponin I levels.

Major adverse events were uncommon in both groups and occurred with similar frequency: 1.2% with nicardipine vs. 3.4% with placebo.

“Larger studies which are better powered to detect significant differences in periprocedural myonecrosis are needed to further explore the potential beneficial effects of nicardipine pretreatment in these patients,” the authors state.

Reference:
CLIM Cardiol 2009;32:315-320.