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Creatine kinase-MB fraction elevation after percutaneous coronary intervention in patients with chronic renal failure
L Gruberg1, R Mehran, R Waksman
1Cardiac Catheterization Laboratory, Washington Hospital Center, Washington, DC 20010, USA. lxg6@mhg.edu
Insights
Patients with chronic renal failure experiencing elevated creatine kinase-myocardial band (CK-MB) levels after percutaneous coronary intervention face higher in-hospital complications and increased mortality. Post-PCI CK-MB elevation greater than 3x normal is a significant predictor of poor outcomes.
Area of Science:
- Cardiology
- Nephrology
- Interventional Cardiology
Background:
- Chronic renal failure (CRF) patients undergoing percutaneous coronary intervention (PCI) are at increased risk for adverse events.
- Creatine kinase-myocardial band (CK-MB) elevation post-PCI can indicate myocardial injury and may have prognostic implications.
Purpose of the Study:
- To evaluate the clinical outcomes of CRF patients with varying degrees of post-PCI CK-MB elevation.
- To identify predictors of short- and long-term mortality in this high-risk population.
Main Methods:
- Retrospective analysis of 326 CRF patients undergoing successful native coronary artery PCI.
- Patients categorized into three groups based on peak post-procedural CK-MB levels: no elevation, 1-3x upper normal limit (UNL), and >3x UNL.
- Clinical outcomes, in-hospital complications, and 1-year mortality were assessed. Multivariate analysis identified independent predictors of mortality.
Main Results:
- Patients with CK-MB >3x UNL experienced significantly higher rates of in-hospital complications, including repeat interventions, pulmonary edema, renal function deterioration, and major bleeding.
- One-year mortality was significantly higher in the CK-MB >3x UNL group (35.4%) compared to the 1-3x UNL (22.0%) and no elevation (16.7%) groups (p=0.007).
- Elevated CK-MB >3x UNL (OR 3.04) and intra-aortic balloon pump use (OR 1.49) were independent predictors of late mortality.
Conclusions:
- Post-PCI CK-MB elevation >3x UNL in CRF patients is associated with increased in-hospital complications and significantly higher 1-year mortality.
- CK-MB levels after PCI are a crucial prognostic marker in CRF patients undergoing revascularization.
- Risk stratification and intensified management are warranted for CRF patients with significant CK-MB elevation post-PCI.
Abstract:
We evaluated the short- and long-term clinical outcomes of 326 consecutive patients with chronic renal failure, not on dialysis, who had creatine kinase (CK)-myocardial band (MB) fraction elevation after successful percutaneous coronary intervention in a native coronary artery. Based on peak CK-MB levels measured after intervention, patients were divided into 3 groups: no elevation (group 1, n = 184), 1 to 3 x upper normal levels (group 2, n = 72), and >3 x upper normal levels (group 3, n = 70). Baseline clinical and angiographic characteristics were similar among the 3 groups. Angiographic success was similar among the 3 groups, although there was a significantly higher use of intra-aortic balloon pump in patients who had postprocedural CK-MB >3 x normal values and a higher rate of in-hospital complications, i.e., repeat catheterization, repeat target lesion intervention, pulmonary edema, renal function deterioration, emergency dialysis, and major bleeding complications. At 1-year follow-up, mortality rates were significantly higher in these patients (35.4% vs 22.0% for patients with CK-MB 1 to 3 x normal values and 16.7% for patients without CK-MB elevation, p = 0.007). Multivariate analysis showed that CK-MB >3 x normal (odds ratio 3.04; 95% confidence interval 1.41 to 6.57, p = 0.005) and intra-aortic balloon pump (odds ratio 1.49; confidence interval 1.15 to 1.93, p = 0.002) were independent predictors of late mortality. Therefore, patients with chronic renal failure who had CK-MB elevation >3 x the upper normal limit after a successful percutaneous coronary intervention had a higher incidence of in-hospital complications and a significantly higher mortality rate at 1-year follow-up than patients without CK-MB elevation or with <3 x normal CK-MB elevation.