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Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Minimal myocardial damage during coronary intervention is associated with impaired outcome
M L Simoons1, M van den Brand, M Lincoff
1Thoraxcenter, Rotterdam, The Netherlands.
Insights
Even small elevations in cardiac enzymes like creatine kinase-MB after percutaneous coronary intervention indicate a higher risk of death or myocardial infarction within six months. These findings highlight the importance of minimizing periprocedural infarcts.
Area of Science:
- Cardiology
- Biomarkers
- Interventional Cardiology
Background:
- Percutaneous coronary intervention (PCI) can lead to procedure-related myocardial infarction (MI), sometimes indicated by elevated cardiac enzymes without clear symptoms.
- The clinical significance of these 'creatine kinase leaks' has been debated.
- Abciximab, a glycoprotein IIb-IIIa receptor blocker, is used in PCI, but periprocedural MI remains a concern.
Purpose of the Study:
- To investigate the relationship between post-procedural creatine kinase-MB (CK-MB) elevation and 6-month clinical outcomes.
- To determine the clinical relevance of minor cardiac enzyme elevations after PCI.
Main Methods:
- Analysis of creatine kinase-MB (CK-MB) or total creatine kinase (CK) levels in 5025 patients from the CAPTURE, EPIC, and EPILOG trials.
- Multivariable analysis to adjust for clinical and angiographic factors.
Main Results:
- A graded increase in 6-month mortality was observed with rising CK-MB or CK levels (ratios relative to upper limit of normal).
- Mortality rates ranged from 1.1% for ratios <1 to 6.7% for ratios >=10.
- The incidence of death or recurrent MI was also associated with CK-MB/CK levels. Age, heart failure history, and enzyme levels were significant predictors of 6-month mortality.
Conclusions:
- Modest elevations in cardiac enzymes (CK-MB, CK) post-PCI are linked to increased 6-month mortality and reinfarction risk.
- These findings underscore the need for strategies to reduce periprocedural myocardial injury.
- Minimizing periprocedural MI during PCI is crucial for improving long-term patient outcomes.
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.
