Cardiac enzyme increase after successful elective stenting

A 66-year-old man presented with effort angina (Canadian Cardiovascular Society Classification II) and inferolateral myocardial ischemia as shown on scintigraphic assessment. The patient had a history of systemic hypertension and type 2 diabetes mellitus requiring insulin. Coronary angiography showed triple-vessel disease and normal left ventricular ejection fraction. After clinical consultation and according to the patient’s preference, elective stent implantation in the right coronary artery was scheduled.

The procedure was performed 3 days later. The patient was pretreated with clopidogrel (Plavix; 75 mg/day) and aspirin (325 mg/day). He was not taking an HMG-CoA reductase inhibitor (statin). Renal function was normal, and glycemic control was acceptable (glycosylated hemoglobin, 7.5%). There were two critical and complex lesions in the proximal and middle segments of the right coronary artery. After predilation with a compliant balloon, two sirolimus-eluting stents were implanted in the proximal and middle segments of the right coronary artery. Stent expansion was optimized with a semicompliant balloon at high pressure (14 atm), resulting in a good angiographic result (residual stenosis < 10% and normal final flow).

The patient was asymptomatic after the procedure, and no changes in the electrocardiogram were observed. Creatine kinase-MB mass, assessed by a radioimmunoassay analyzer (Stratus CS — STAT Fluorometric Analyzer; Dade Behring Marburg GmbH, Marburg/Germany), was 0.80 ng/mL before stenting, 3.5 ng/mL 6 hours after stenting, and 20.80 ng/mL 12 hours after stenting. Cardiac troponin I was 0.01 ng/mL before stenting, 0.15 ng/mL 6 hours after stenting, and 2.33 ng/mL 12 hours after stenting. The patient was discharged on the second day after the procedure, with prescriptions for aspirin, clopidogrel, a statin, an angiotensin-converting enzyme inhibitor, nitrate, and a beta blocking agent.