POST-PCI CLINICAL OUTCOME;

CO-RELATION WITH CARDIAC BIOCHEMICAL MARKERS

Abstract

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–Qwave
and Q-wave myocardial infarction. Whereas the deleterious effect on survival of large
periprocedural myocardial infarctions have been well documented. Large periprocedural
myocardial infarctions, such as those caused by occlusion of a large side branch, flow-limiting
dissection, or distal embolization of a large thrombus, would be undesirable and associated
with worse subsequent cardiac outcomes. Objectives: To correlate the clinical outcome
after PCI with cardiac biochemical markers. Study Design: Observational follow-up study.
Setting: Faisalabad Institute of Cardiology, Faisalabad. Duration of Study with Dates: Six
months (February, 2014 to August, 2014). Patients and Methods: Two hundred patients with
symptoms of myocardial ischemia proceeding for percutaneous coronary intervention were
enrolled in the study. After taking history and clinical examination, the patients divided into two
groups: group I and group II. Group I comprised one hundred and fifty patients having normal
cardiac 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 complications
dissection (6%), side branch compromise (14%), slow flow (10%), no reflow (2%), sub-acute
stent thrombosis (4%) occurred in group II as compared to slow flow (1.4%) and sub-acute
stent thrombosis (0.7%) in group I. In hospital mortality (2%) in group II while no mortality in
group I. On thirty day follow up 32% patients became symptomatic among which 6% developed
non 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 group
I. Conclusion: Patients with raised cardiac enzymes had worse clinical outcome in terms of
mortality, myocardial infarction and repeat target lesion revascularization than normal cardiac
enzymes.