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Creatine kinase-MB enzyme elevation following successful saphenous vein graft intervention is associated with late
1Cardiovascular Research Foundation, Washington Hospital Center, Washington, DC, USA.
Insights
Major creatine kinase-MB (CK-MB) elevation after saphenous vein graft (SVG) intervention predicts higher long-term mortality. This risk persists even without other complications, highlighting CK-MB as a key prognostic marker.
Area of Science:
- Cardiology
- Interventional Cardiology
- Biomarkers
Background:
- Saphenous vein graft (SVG) interventions carry a high risk of creatine kinase-MB (CK-MB) elevation.
- The prognostic value of periprocedural CK-MB elevation after SVG intervention is not well-established.
Purpose of the Study:
- To investigate the impact of periprocedural CK-MB elevation on late clinical events after successful SVG angioplasty.
Main Methods:
- A cohort of 1056 patients with successful SVG interventions was analyzed.
- Patients were stratified into groups based on CK-MB levels: normal, minor rise (1-5x normal), and major rise (>5x normal).
- Clinical events and mortality were assessed at 30-day and 1-year follow-up.
Main Results:
- No significant differences in 30-day major clinical events were observed across CK-MB groups.
- One-year mortality rates were significantly higher in patients with minor (6.5%) and major (11.7%) CK-MB elevations compared to normal (4.8%).
- Major CK-MB elevation was the strongest independent predictor of late mortality (OR 3.3), followed by diabetes mellitus.
Conclusions:
- Major CK-MB elevation occurs in 15% of successful SVG interventions.
- Periprocedural CK-MB elevation is significantly associated with increased late mortality following SVG angioplasty.
Background:
Although the risk for development of creatine kinase (CK-MB) elevation after saphenous vein graft (SVG) intervention is high, its prognostic significance remains unknown. This study evaluated the impact of periprocedural CK-MB elevation on late clinical events following successful SVG angioplasty.
Methods And Results:
We studied 1056 consecutive patients with successful (defined by angiographic success and absence of major complications) intervention of 1693 SVG lesions. These patients were grouped as normal CK-MB (n=556), minor CK-MB rise (CK-MB 1 to 5 times normal, n=339), and major CK-MB rise (CK-MB >5 times normal, n=161). There were no differences in major clinical events at 30-day follow-up among the 3 groups. However, 1-year mortality was 4.8%, 6.5%, and 11. 7%, respectively, P<0.05 (ANOVA). Even within a population without any intraprocedure or in-hospital complications (n=727, 69% of the overall cohort), 1-year mortality remained significantly higher with CK-MB elevation: 2.4%, 5.5%, and 10.7%, respectively, P<0.05 (ANOVA). Multivariate analysis revealed major CK-MB elevation as the strongest independent predictor of late mortality (odds ratio 3.3, with 95% CI 1.7 to 6.2), followed by diabetes mellitus (odds ratio 2. 6, with 95% CI 1.5 to 4.5).
Conclusions:
Major CK-MB elevation occurs after 15% of otherwise successful SVG interventions and is associated with increased late mortality.
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