Effect of Intracoronary Nicardipine on Cardiac Enzymes After Elective Percutaneous Coronary Intervention

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 > 1× 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. Copyright © 2009 Wiley Periodicals, Inc.