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Published on: May 28, 2019
Mortality risk conferred by small elevations of creatine kinase-MB isoenzyme after percutaneous coronary intervention
John P A Ioannidis1, Evangelia Karvouni, Demosthenes G Katritsis
1Department of Hygiene and Epidemiology, University of Ioannina School of Medicine and the Biomedical Research Institute, Foundation for Research and Technology, Hellas- Ioannina, Greece. jioannid@cc.uoi.gr
Objectives:
The aim of this study was to assess whether small creatine kinase-MB isoenzyme (CK-MB) elevations after percutaneous coronary intervention (PCI) affect the subsequent mortality risk.
Background:
Several studies have evaluated the relationship of CK-MB levels after PCI with the subsequent risk of death. While there is consensus that elevations exceeding 5 times the upper limit of normal increase mortality significantly, there is uncertainty about the exact clinical impact of smaller CK-MB elevations.
Methods:
We performed a meta-analysis of seven studies with CK-MB measurements and survival outcomes on 23230 subjects who underwent PCI. Data were combined with random effects models.
Results:
Mean follow-up was 6 to 34 months per study. By random effects, 19% (95% confidence interval [CI], 16% to 23%) had one- to five-fold CK-MB elevations, while only 6% (95% CI, 5% to 9%) had >5-fold elevations. Compared with subjects with normal CK-MB, there was a dose-response relationship with relative risks for death being 1.5 (95% CI, 1.2 to 1.8, no between-study heterogeneity) with one- to three-fold CK-MB elevations, 1.8 (95% CI, 1.4 to 2.4, no between-study heterogeneity) with three- to five-fold CK-MB elevations, and 3.1 (95% CI, 2.3 to 4.2, borderline between-study heterogeneity) with over five-fold CK-MB elevations (p < 0.001 for all).
Conclusions:
Any increase in CK-MB after PCI is associated with a small, but statistically and clinically significant, increase in the subsequent risk of death.
Insights
Even small elevations in creatine kinase-MB (CK-MB) after percutaneous coronary intervention (PCI) are linked to increased mortality risk. This meta-analysis confirms that any CK-MB increase post-PCI warrants attention for patient outcomes.
Area of Science:
- Cardiology
- Biomarker analysis
- Clinical outcomes research
Background:
- Elevated creatine kinase-MB (CK-MB) post-percutaneous coronary intervention (PCI) is a known risk factor for mortality.
- While significant CK-MB elevations (>5 times upper limit of normal) are clearly linked to increased death risk, the impact of smaller elevations remains uncertain.
Purpose of the Study:
- To evaluate the association between minor CK-MB elevations following PCI and subsequent mortality risk.
- To clarify the clinical significance of small CK-MB level increases after PCI.
Main Methods:
- A meta-analysis was conducted on seven studies involving 23,230 patients who underwent PCI.
- Data on CK-MB measurements and survival outcomes were combined using random-effects models.
Main Results:
- 19% of patients experienced one- to five-fold CK-MB elevations, and 6% had >5-fold elevations.
- A dose-response relationship was observed: relative risks for death were 1.5 (1-3 fold), 1.8 (3-5 fold), and 3.1 (>5 fold) compared to normal CK-MB levels.
- All observed increases in CK-MB were statistically significant predictors of mortality.
Conclusions:
- Any elevation in CK-MB levels after PCI is associated with a statistically significant increase in the risk of death.
- This increase in mortality risk, though small, is clinically significant and highlights the importance of monitoring CK-MB levels post-PCI.
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