(Circulation. 1999;99:2085-2089.)
© 1999 American Heart Association, Inc.
Clinical Investigation and Reports |
Beneficial Impact of Preconditioning During PTCA on Creatine Kinase Release
From the Division of Cardiology, Department of Medicine, University of Maryland School of Medicine, Baltimore, Md.
Correspondence to Dr Warren K. Laskey, Cardiac Catheterization Laboratory, University of Maryland Medical Systems, 22 S Greene St, Room S3B08, Baltimore, MD 21201-1595. E-mail wlaskey{at}medicine.ab.umd.edu
Background—Previous studies in humans have indicated that there is less ischemic dysfunction during PTCA when ischemic preconditioning is elicited. However, the clinical relevance of these observations remains unclear. The present study design tests the hypothesis that PTCA performed to elicit the preconditioning response would result in less myocardial necrosis as assessed by postprocedure creatine kinase (CK) levels
Methods and Results—Patients (n=150) undergoing PTCA for unstable ischemic syndromes were randomly assigned to receive a previously validated approach to PTCA-mediated preconditioning (PC) or an unrestricted approach to balloon angioplasty (UC). CK levels were determined at 8, 12, and, if necessary, 24 hours. Clinical success rates were equivalent for the 2 groups. However, the frequency of any CK elevation was significantly higher in the UC group (25%) than in the PC group (7.1%) (P<0.005). Multivariable analysis confirmed a significant effect of preconditioning on CK release.
Conclusions—A standardized protocol to elicit preconditioning during PTCA results in a significant reduction in the rate of CK elevation in a high-risk population. These observations support the clinical relevance of ischemic preconditioning in humans.
Key Words: ischemia • angioplasty • creatine kinase • balloon
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