Creatine kinase-MB elevation after percutaneous coronary intervention predicts adverse outcomes in patients with acute coronary syndromes.
AIM: To study the relationship between outcomes and peak creatine kinase (CK)-MB levels after percutaneous coronary intervention (PCI) in patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS). METHODS AND RESULTS: Peak CK-MB ratios (peak CK-MB level/upper limit of normal [ULN]) after PCI were analysed in 6164 patients with NSTE ACS from four randomized trials who underwent in-hospital PCI. We excluded 696 patients with elevated CK or CK-MB levels <24h before PCI; the primary analysis included 2384 of the remaining 5468 patients (43.6%) with CK-MB levels measured <==24h after PCI. The incidence of in-hospital heart failure (0.1%, 0.8%, 3.4%, 4.1%, and 6.1%; P<0.001), arrhythmias (0.8%, 1.9%, 6.9%, 4.1%, and 7.9%; P<0.001), cardiogenic shock (0.1%, 1.3%, 2.0%, 2.3%, and 2.6%; P=0.004), and mortality through 6 months (2.1%, 2.4%, 4.9%, 4.1%, and 5.7%, P=0.005) was increased with peak CK-MB ratios of 0-1, 1-3, 3-5, 5-10, and >10xULN, respectively. The continuous peak CK-MB ratio after PCI significantly predicted adjusted 6-month mortality (risk ratio, 1.06 per unit increase above ULN; 95% confidence interval, 1.01-1.11; P=0.017). CONCLUSIONS: Greater CK-MB elevation after PCI is independently associated with adverse outcomes in NSTE ACS. These results underscore the adverse implications of elevated CK-MB levels after PCI in this high-risk population.
|Keywords||Acute Disease, Aged, Biological Markers/blood, Comparative Study, Coronary Disease/*enzymology/mortality/therapy, Creatine Kinase, MB Form, Creatine Kinase/*metabolism, Female, Hospital Mortality, Humans, Isoenzymes/*metabolism, Male, Middle Aged, Multivariate Analysis, Patient Selection, Research Support, Non-U.S. Gov't, Treatment Outcome, acute coronary syndromes, biomarkers, percutaneous coronary interventions, prognosis|
|Persistent URL||dx.doi.org/10.1016/j.ehj.2003.12.009, hdl.handle.net/1765/13312|
Roe, M.T., Mahaffey, K.W., Kilaru, R., Akkerhuis, K.M., Simoons, M.L., Harrington, R.A., … Armstrong, P.W.. (2004). Creatine kinase-MB elevation after percutaneous coronary intervention predicts adverse outcomes in patients with acute coronary syndromes.. European Heart Journal, 25(4), 313–321. doi:10.1016/j.ehj.2003.12.009