β-Blockers Before Percutaneous Coronary Intervention Do Not Attenuate Postprocedural Creatine Kinase Isoenzyme Rise

Abstract

Background-␤-blocker (BB) use reduces infarct size in spontaneously occurring nonreperfused infarcts but probably does not change infarct size in patients treated with reperfusion therapy. A recent observational study suggested that BB use concurrent with percutaneous coronary intervention (PCI) decreased the risk of creatine kinase (CK)-MB elevation. The cogency of such a conclusion is dependent on the ability to risk-adjust for the multiple differences in patients treated with and without BBs. Methods and Results-Using propensity score and multivariate regression analyses, 6200 consecutive patients were analyzed to assess the relationship between BB use before PCI and per protocol-measured CK and CK-MB rise. There were several highly significant (PϽ0.001) differences between patients with and without BB treatment (eg, age, prior infarction, unstable angina

Distal Myocardial Protection During Percutaneous Coronary Intervention With an Intracoronary β-Blocker

“…23,24 The possible benefit from long-term oral ␤-blocker use was examined in an observational retrospective study that showed a reduction in the incidence of MI in patients who were taking long-term oral ␤-blocker therapy before PCI compared with those who were not. 25 However, a second large retrospective analysis did not confirm this finding, 26 nor did the present study (see Figure 3). In the present study, patients taking long-term oral ␤-blockers had a similar benefit to those who were not, demonstrating the additional benefit of IC propranolol (Figure 4).…”

Periprocedural Cardiac Enzyme Elevation Predicts Adverse Outcomes

“…40 ␤-blockers have been shown in some analyses to reduce periprocedural MI, whereas other analyses have disputed this finding. 41,42 Although markers of inflammation such as hsCRP appear capable of predicting embolization and myonecrosis, other inflammatory markers such as soluble CD40L or myeloperoxidase may prove to be of greater utility. More likely, panels of inflammatory markers measured before PCI would provide greater incremental prognostic ability.…”

Utility of Intravenous β-Blocker Administration in Patients with Acute Myocardial Infarction Undergoing Primary Percutaneous Intervention

“…0.001). Conversely, in a study by Ellis et al [29] of 6,200 PCI patients (66% with unstable angina), pre-intervention ␤ -blocker use was not associated with peri-procedural infarction.…”

“…Chronic pre-intervention oral ␤ -blockers has been reported by some [28] , but not others [29] , to be associated with reduced peri-procedural infarctions in patients undergoing elective PCI. Sharma et al [28] analyzed the outcomes of 1,675 consecutive patients undergoing elective PCI with respect to ␤ -blocker use before the intervention.…”