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Relation between coronary atherosclerotic plaque burden and cardiac enzyme elevation following percutaneous coronary
1Department of Medicine (Cardiovascular Medicine), Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York 10461, USA.
Insights
Cardiac creatine kinase (CK) elevation after percutaneous coronary intervention (PCI) may indicate more extensive atherosclerosis. This finding suggests CK elevation is a marker for worse prognosis in patients undergoing PCI.
Area of Science:
- Cardiology
- Interventional Cardiology
- Biomarkers
Background:
- Cardiac creatine kinase (CK) elevation post-percutaneous coronary intervention (PCI) is linked to adverse outcomes.
- The role of CK elevation as a cause versus a marker of these events is unclear.
Purpose of the Study:
- To investigate the correlation between angiographically determined atherosclerotic plaque burden and CK elevation after PCI.
- To determine if CK elevation is a marker for underlying atherosclerosis.
Main Methods:
- A case-control study comparing patients with CK elevation (cases, n=23) post-PCI to matched controls (n=46) without CK elevation.
- Quantitative angiographic analysis to assess coronary artery atherosclerotic plaque burden (luminal irregularity).
- Comparison of clinical characteristics including smoking status and lesion types.
Main Results:
- The CK elevation group showed significantly higher rates of smoking (65% vs 33%) and thrombus-containing lesions (22% vs 2.2%).
- Abrupt closure was more frequent in the CK elevation group (13% vs 0%).
- Atherosclerotic plaque burden was 50% greater in cases compared to controls (30% vs 20%).
Conclusions:
- CK elevation after PCI is associated with a greater atherosclerotic plaque burden.
- These findings suggest CK elevation serves as a marker for more extensive atherosclerosis, potentially explaining the poorer prognosis observed in these patients.
Abstract:
Several studies have reported that elevation of cardiac creatine kinase (CK) enzymes after percutaneous coronary intervention (PCI) is associated with an increase in cardiac morbidity and mortality during follow-up. However, it remains unclear if enzyme elevation contributes to the adverse outcomes or is simply a marker for adverse events. We conducted a case-control study to determine if angiographically determined atherosclerotic plaque burden correlated with CK elevation. Patients (cases, n = 23) with CK elevation after PCI were identified along with 46 age- and gender-matched controls without CK elevation. Detailed angiographic analysis quantified the percentage of coronary artery length with any luminal irregularity, a surrogate for plaque burden. The CK elevation group was characterized by a greater number of smokers (65% vs 33%, p = 0.02), more thrombus-containing lesions (22% vs 2.2%, p = 0.014), and more frequent abrupt closure (13% vs 0%, p = 0.03). In addition, the case group had a 50% increase in atherosclerotic plaque burden compared with controls (30 +/- 14% vs 20 +/- 14%, p = 0.006). These data suggest that CK elevation after PCI is a marker for more extensive atherosclerosis, which may explain the worse prognosis of these patients.