Beneficial impact of preconditioning during PTCA on creatine kinase release

Abstract

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 proconditioning (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.