Aims: To assess the significance of creatine kinase (CK)-MB elevations in outcomes of patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS) who have undergone coronary artery bypass grafting (CABG) surgery. Methods and results: This analysis includes data from 26 465 patients with NSTE ACS enrolled in four major trials. In total, 4626 (17.5%) of patients had CABG within 30 days. Patients were excluded if CK-MB was elevated within 24 h before surgery and there was no CK-MB measured after surgery. Overall, 4401 patients were included in these analyses. The incidence of mortality increased with peak CK-MB ratios of 0-1, > 1-3, > 3-5, > 5-10, and > 10 x the upper limit of normal measured at the local lab (P < 0.001 across categories): 1.1, 2.8, 2.4, 3.1, and 10.8% in hospital; 1.1, 3.0, 2.9, 3.5, and 10.2% at 30 days; and 1.6, 4.4, 4.7, 6.0, and 10.9% at 180 days. Multivariable predictors of 6-month mortality included age, heart rate and randomization, peak CK-MB ratio, time to CABG, prior angina, signs of congestive heart failure and randomization, three- and two-vessel coronary disease, enrolment infarction, ST-segment depression at enrolment, female sex, experimental treatment, and systolic blood pressure. Conclusion: CK-MB elevations after CABG are independently associated with increased risk of mortality in patients with NSTE ACS.

Acute coronary syndrome, Clinical endpoints, Coronary artery bypass graft, Creatine kinase-MB elevation, Myocardial infarction,
European Heart Journal
Erasmus MC: University Medical Center Rotterdam

Mahaffey, K.W, Roe, M.T, Kilaru, R, Alexander, J.H.P, van de Werf, F.J.J, Califf, R.M, … Harrington, R.A. (2007). Creatine kinase-MB elevation after coronary artery bypass grafting surgery in patients with non-ST-segment elevation acute coronary syndromes predict worse outcomes: Results from four large clinical trials. European Heart Journal, 28(4), 425–432. doi:10.1093/eurheartj/ehl483