Minimal myocardial damage during coronary intervention is associated with impaired outcome
AIMS: Studies on the glycoprotein IIb-IIIa receptor blocker abciximab in patients undergoing percutaneous coronary intervention consistently show a reduction in procedure-related myocardial infarction. Some such infarcts are characterized by elevated creatine kinase or creatine kinase-MB, without apparent clinical symptoms. The clinical relevance of such 'creatine kinase leaks' has been questioned. Therefore we investigated the relationship between post-procedural creatine kinase-MB elevation and outcome at the 6 month follow-up. METHODS AND RESULTS: Creatine kinase-MB, or total creatine kinase values were analysed in 5025 out of 6156 patients enrolled in the CAPTURE, EPIC and EPILOG studies. A consistent gradual increase in 6 month mortality was observed as creatine kinase-MB or creatine kinase levels increased: 1.1%, 2.1%, 1.8%, 3. 6% and 6.7% for creatine-MB or creatine ratios (relative to upper limit of normal) <1, 1-3, 3-5, 5-10 and >/=10, respectively. Also the incidence of death or (recurrent) myocardial infarction was related to creatine kinase-MB or creatine kinase ratios. Subsequent revascularization was not related to periprocedural myocardial infarction. By multivariable analysis, correcting for clinical and angiographic characteristics, mortality at 6 months was related to the enzyme (creatine kinase, creatine kinase-MB) ratio, a history of heart failure and age. The combined end-point of death and myocardial infarction was also related to these factors, as well as to a history of bypass surgery and unstable angina. CONCLUSION: Modest elevation of cardiac enzymes (creatine kinase-MB, creatine kinase) after percutaneous coronary intervention is associated with an increased risk of mortality and reinfarction during the 6 month follow-up. Measures to reduce such periprocedural infarcts are warranted.
|Keywords||*Angioplasty, Transluminal, Percutaneous Coronary, Antibodies, Monoclonal/therapeutic use, Creatine Kinase/*blood, Humans, Immunoglobulin Fab Fragments/therapeutic use, Isoenzymes, Myocardial Infarction/drug therapy/*enzymology/mortality/*therapy, Platelet Aggregation Inhibitors/therapeutic use, Recurrence, Survival Analysis, Treatment Outcome|
|Persistent URL||dx.doi.org/10.1053/euhj.1999.1521, hdl.handle.net/1765/5597|
Simoons, M.L., Lincoff, A.M., Harrington, R.A., Vahanian, A., Rutsch, W.R., Kootstra, J.G., … van der Wieken, L.R.. (1999). Minimal myocardial damage during coronary intervention is associated with impaired outcome. European Heart Journal, 20(15), 1112–1119. doi:10.1053/euhj.1999.1521