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Creatine kinase-MB elevation after coronary intervention correlates with diffuse atherosclerosis, and low-to-medium
1Cardiac Catheterization Laboratory of the Zena and Michael A. Weiner Cardiovascular Institute, Mount Sinai Hospital, New York, New York 10029-6574, USA.
Insights
Creatine kinase-MB isoenzyme (CK-MB) elevation after coronary intervention is common, particularly with non-balloon devices. Mild elevations (1-5x normal) do not impact midterm survival, suggesting safe early discharge for stable patients.
Area of Science:
- Cardiology
- Biomarkers
- Interventional Cardiology
Background:
- Creatine kinase-MB isoenzyme (CK-MB) elevation post-coronary intervention historically linked to adverse outcomes, primarily with balloon angioplasty.
- The prognostic significance of CK-MB elevation following non-balloon device interventions remains unclear.
Purpose of the Study:
- To determine the incidence and predictors of CK-MB elevation after contemporary coronary interventions.
- To assess the impact of CK-MB elevation on in-hospital outcomes and midterm survival.
Main Methods:
- Prospective study of 1,675 consecutive patients undergoing coronary intervention.
- Monitoring for in-hospital events and midterm survival following intervention.
Main Results:
- CK-MB elevation occurred in 18.7% of patients, more frequently after non-balloon devices (19.5%) than percutaneous transluminal coronary angioplasty (11.5%).
- Predictors included diffuse coronary disease, systemic atherosclerosis, stent use, and absence of beta-blocker therapy.
- Adverse in-hospital events were higher only in patients with CK-MB elevation >5x normal; midterm survival was similar across groups.
Conclusions:
- CK-MB elevation post-coronary intervention can occur without procedural complications and is associated with diffuse atherosclerosis.
- Only significant CK-MB elevation (>5x normal) correlated with increased in-hospital events.
- Early discharge for stable patients with mild CK-MB elevation (1-5x normal) after successful intervention is deemed safe.
Objectives:
The study evaluated the incidence and predictors of creatine kinase-MB isoenzyme (CK-MB) elevation after successful coronary intervention using current devices, and assessed the influence on in-hospital course and midterm survival.
Background:
The CK-MB elevation after coronary intervention predominantly using balloon angioplasty correlates with late cardiac events of myocardial infarction (MI) and death. Whether CK-MB elevation after nonballoon devices is associated with an adverse short and midterm prognosis is unknown.
Methods:
The incidence and predictors of CK-MB elevation after coronary intervention were prospectively studied in 1,675 consecutive patients and were followed for in-hospital events and survival.
Results:
CK-MB elevation was detected in 313 patients (18.7%), with 1-3x in 12.8%, 3-5x in 3.5% and >5x normal in 2.4% of patients. Procedural complications or electrocardiogram changes occurred in only 49% of the CK-MB-elevation cases; CK-MB elevation was more common after nonballoon devices (19.5% vs. 11.5% after percutaneous transluminal coronary angioplasty; p < 0.01). Predictors of CK-MB elevation on multivariate analysis were diffuse coronary disease (p = 0.02), systemic atherosclerosis (p = 0.002), stent use (p = 0.04) and absence of beta-blocker therapy (p = 0.001). Adverse in-hospital cardiac events were more frequent in patients with >5x CK-MB elevation, with no significant difference between 1-5x CK-MB elevation versus normal CK-MB group. During a mean follow-up of 13 +/- 3 months, the incidence of death in the CK-MB-elevation group was 1.6% versus 1.3% in the normal CK-MB group (p = NS).
Conclusions:
The CK-MB elevation after coronary intervention was observed even in the absence of discernible procedural complications and was more common in patients with diffuse atherosclerosis. In-hospital clinical events requiring prolonged monitoring were higher in >5x CK-MB-elevation patients only. Midterm survival of CK-MB-elevation patients was similar to those with normal CK-MB. Our prospective analysis shows a lack of adverse in-hospital cardiac events and suggests that early discharge of stable 1-5x normal CK-MB-elevation patients after successful coronary intervention is safe.