February 12, 1997

Periprocedural Cardiac Marker Elevation After Percutaneous Coronary Artery RevascularizationImportance and Implications

Author Affiliations

From the Division of Cardiology, Department of Medicine (Dr Ohman), and Division of Cardiothoracic Anesthesia, Department of Anesthesiology (Dr Tardiff), Duke University Medical Center, Durham, NC.

JAMA. 1997;277(6):495-497. doi:10.1001/jama.1997.03540300063035

Up to 1 million patients annually may be undergoing percutaneous coronary revascularization with procedures including angioplasty, stent implantation, and atherectomy by the end of this decade.1 Periprocedural myocardial infarction (MI) may occur in up to 14% of patients undergoing these procedures.2,3 In the late 1980s, transient elevations of cardiac enzymes, such as creatine kinase (CK), were shown to occur relatively often despite a lack of symptoms indicative of MI.4-6 Limited, short-term follow-up of small numbers of patients suggested that there was no increased risk of late adverse events in patients with such elevations.4,5

See also p 461.

In the early 1990s, several new antithrombotic therapies and devices were tested prospectively in patients undergoing percutaneous interventions.2,7 Transient elevations in cardiac markers, some similar to levels seen in a typical MI, were shown to occur in 20% to 40% of patients.8-10 Later examination of several large