Effect of sevoflurane on serum CK-MB levels after percutaneous coronary stent placement: prospective randomized clinical trial

Background: Markers of myocardial injury, such as creatine kinase myocardial band (CK-MB mass), are elevated in up to 30% of patients undergoing percutaneous coronary intervention (PCI) with stent deployment. This elevation represents myocardial injury that can impact the patient in the long term, including the risk of death. Sevoflurane, an inhaled anesthetic, may have cardioprotective properties, benefiting patients undergoing PCI.Methods: Randomized (1:1), double-blind, placebo-controlled trial enrolling patients with CAD eligible for PCI. The primary objective was to compare serum CK-MB mass raise in both groups. Additionally, we compared substantial elevations in CK-MB mass (defined as > 5x the upper limit of normal), length of stay in the ICU and in hospital, and one-year mortality.Results: 1,254 patients were randomized to receive sevoflurane (2% inspired fraction) or placebo (oxygen alone) for 30 minutes prior to PCI. Patients having experienced acute MI within 72h and those with stents in SVG were excluded. Sevoflurane was unable to promote cardioprotection, as determined by CK-MB mass levels (sevoflurane group: 2.52 ± 9.64; control group: 1.84 ± 8.58; p = 0.32). No effect was noticed on the reduction among patients who increase marker levels (prevalence of increase in CK-MB mass greater than the upper limit of normality = 30.8% in the sevoflurane group and 28.9% in the control group; p = 0.33; 4.6% vs. 3.1%, respectively, for increases 5x above the upper limit of normality [p = 0.21]).Conclusion: Sevoflurane failed to reduce myocardial injury after PCI. Therefore, its usage should not be routinely recommended.