Clinical Outcome of Patients with Elevated Cardiac Markers after Percutaneous Coronary Intervention

Aim: To determine early clinical outcome in patients with normal and elevated cardiac enzymes after percutaneous coronary intervention (PCI). Methods: From February 2009 to January 2010, total of 200 consecutive patients fulfilling the inclusion and exclusion criteria, who underwent PCI at Punjab Institute of Cardiology, Lahore were included in this survey. A prospective observational study was carried. Patients were divided into two groups randomly. The blood sample was drawn within 24 hours of the procedure and creatine kinase-myocardial band (CK-MB) level was analyzed. Based on cardiac enzyme level, Patients were divided into two groups; 150 patients in Group I with normal CK-MB level and 50 patients in group II above the upper reference limit. The primary end point of the study was in-hospital or 30 day mortality. Secondary clinical end points were major adverse cardiac events (MACE) including Q-wave and non-Q-wave myocardial infarction, emergent coronary artery bypass operation, or repeat target lesion revascularization (TLR) at 30 days after the index operation. Results: During the study, out of 150 patients in Group I, Periprocedural complications were dissection (6%), side branch compromise (14%), slow flow (10%), no reflow (2%), sub-acute stent thrombosis (4%). In the other hand, out of 50 patients in Group II, slow flow was seen in 1.4% and Sub-acute stent thrombosis in 0.7%. 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 the group I. 6% patients needed repeat target lesion revascularization in group II and only 0.7% in group I. Conclusions: The findings confirm that raising cardiac enzymes had a worse clinical outcome in terms of mortality, myocardial infarction and repeat target lesion revascularization as compared to normal cardiac enzymes post PCI.