Creatine kinase-MB elevation after percutaneous coronary intervention predicts adverse outcomes in patients with acute coronary syndromes.
February 2004
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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.
- Male
- Comparative Study
- Aged
- Female
- Humans
- Research Support, Non-U.S. Gov't
- Biological Markers/blood
- Multivariate Analysis
- Acute Disease
- Middle Aged
- Treatment Outcome
- acute coronary syndromes
- prognosis
- biomarkers
- Isoenzymes/*metabolism
- Patient Selection
- Hospital Mortality
- Coronary Disease/*enzymology/mortality/therapy
- Creatine Kinase, MB Form
- Creatine Kinase/*metabolism
- percutaneous coronary interventions
- ck-mb
- patient
- peak ck-mb ratios
- elevation
- ratio
- mortality
- level
- 6- month mortality
- peak ck-mb ratio
- trial
- intervention
- ck-mb levels
- periprocedural
- category
- infarction
- peak ck-mb categories
- month
- <0.001
- model
- treatment
