From the Guidelines
Yes, it is possible to develop increased liver function tests (LFTs) after percutaneous coronary intervention (PCI). This elevation can occur due to several factors related to the procedure, as outlined in the guidelines on myocardial revascularization 1. Medications administered during and after PCI, particularly statins, can occasionally cause liver enzyme elevations. According to the guidelines, liver enzymes should be evaluated initially, 8–12 weeks after statin initiation, after dose increase, then annually or more frequently if indicated 1. The contrast media used during angiography may also affect liver function in some patients. Additionally, some patients might experience hypotension during the procedure, potentially leading to reduced liver perfusion and transient liver injury.
Key Considerations
- Medications such as statins, which are commonly prescribed or continued after PCI, can cause LFT elevations 1.
- Contrast media used during angiography may affect liver function.
- Hypotension during the procedure can lead to reduced liver perfusion and transient liver injury.
- Monitoring of LFTs is crucial, especially in patients with pre-existing liver conditions or those taking medications known to affect liver function.
Recommendations for Monitoring and Management
- Evaluate liver enzymes initially, 8–12 weeks after statin initiation, after dose increase, then annually or more frequently if indicated 1.
- Monitor LFTs closely in patients who have undergone PCI, especially if they are taking medications that can affect liver function.
- Consult with a cardiologist before discontinuing any prescribed medications if increased LFTs are observed.
- Further investigation is warranted if LFT elevations are persistent or significantly elevated to rule out other causes of liver dysfunction.
From the Research
Development of Increased LFTs Post PCI
- There is limited direct evidence on the development of increased Liver Function Tests (LFTs) post Percutaneous Coronary Intervention (PCI) 2, 3, 4, 5, 6.
- However, studies have shown that patients with end-stage liver disease undergoing PCI are at a higher risk of complications and in-hospital outcomes 3.
- The use of contrast agents during PCI can result in contrast-induced nephropathy (CIN), but there is no direct evidence on the effect of contrast agents on LFTs 4, 5, 6.
- A study on the renal tolerability of iopromide and iodixanol in renally impaired patients undergoing cardiac catheterisation found no significant difference in the incidence of CIN between the two contrast agents 4.
- Another study compared the clinical safety of iso-osmolar contrast medium iodixanol to low-osmolar contrast medium iopromide in patients with renal insufficiency undergoing coronary angiography with or without PCI, and found no significant difference in the incidence of CIN 5.
- A study on the effects of a high dose of the contrast medium iodixanol on renal function in patients following PCI found that the administration of high-dose iodixanol is associated with low rates of CI-AKI, but did not investigate the effect on LFTs 6.
- A study on elevated liver enzymes in an acute medical setting found that the common conditions that resulted in elevated liver enzymes were sepsis and alcohol-related liver diseases, but did not investigate the effect of PCI on LFTs 2.