Prospective analysis of possible myocardial damage or hemolysis occurring as a result of prolonged autoperfusion angioplasty in humans

• Published in: Journal of the American College of Cardiology 1992-09, Vol.20 (3), p.594-598
• Main Authors: Muhlestein, Joseph B., Quigley, Peter J., Ohman, Erik Magnus, Bauman, Robert P., Sketch, Michael H., Tcheng, James E., Davidson, Charles J., Peter, Robert H., Behar, Victor S., Krucoff, Mitchell W., Kong, Yihong, Phillips, Harry R.
• Format: Article
• Language: English
• Subjects: Aged; Angioplasty, Balloon, Coronary - adverse effects; Angioplasty, Balloon, Coronary - instrumentation; Angioplasty, Balloon, Coronary - methods; Biological and medical sciences; Cardiology. Vascular system; Coronary heart disease; Creatine Kinase - blood; Electrocardiography; Female; Heart; Hemolysis; Humans; Male; Medical sciences; Middle Aged; Myocardium - pathology; Prospective Studies; Treatment Outcome
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/0735-1097(92)90013-D

Objectives. The purpose of this study was to further explore the procedural safety of prolonged (15-min) dilation using an autoperfusion coronary angioplasty balloon by assessing the degree of myocardial damage or hemolysis, if any, occurring as a result of the procedure. Background. Prolonged balloon inflation periods may be beneficial during percutaneous transluminal coronary angioplasty. The duration of standard balloon angioplasty is often limited by the occurrence of myocardial ischemia due to loss of anterograde blood flow. Autoperfusion angioplasty allows continued myocardial perfusion during balloon inflation and has previously been shown to reduce but not totally eliminate acute myocardial ischemia during prolonged (up to 15 min) balloon inflation. The risk of intravascular hemolysis as a result of autoperfusion angioplasty has not yet been fully delineated. Methods. Sixty-two consecutive patients (76% men; mean age 58 years) undergoing elective percutaneous transluminal coronary angioplasty of a single lesion were studied. Serial electrocardiographic and creatine kinase MB isoenzyme data were examined to detect evidence of myocardial damage. Tests for hemolysis (plasma free hemoglobin, serum haptoglobin and serum lactate dehydrogenase) were obtained in the 1st 24 consecutive patients. Results. Inflation time was 14 ± 4 min (mean ± SD) and the procedure was successful (≤ 50% residual lesion stenosis) in 59 patients (95%). Electrocardiographic evidence of myocardial infarction (> 1 mm persistent ST segment depression, > 1 mm ST segment elevation or new Q waves) was not observed in any patient. Cardiac enzyme assays were within the normal range in all patients. No evidence of hemolysis was found in the 24 consecutive patients studied. Conclusions. We conclude that prolonged autoperfusion angioplasty can be performed in patients without clinical evidence of myocardial damage or hemolysis.