Creatine kinase-MB elevation after percutaneous coronary intervention predicts adverse outcomes in patients with
M T Roe1, K W Mahaffey, R Kilaru
1Duke Clinical Research Institute, Durham, North Carolina, USA. roe00001@mc.duke.edu
Insights
Higher peak creatine kinase-MB (CK-MB) levels after percutaneous coronary intervention (PCI) in non-ST-segment elevation acute coronary syndromes (NSTE ACS) patients are linked to increased risks of heart failure, arrhythmias, and mortality.
Area of Science:
- Cardiology
- Biomarkers
- Interventional Cardiology
Background:
- Elevated cardiac biomarkers post-percutaneous coronary intervention (PCI) can indicate myocardial injury.
- Non-ST-segment elevation acute coronary syndromes (NSTE ACS) represent a significant patient population undergoing PCI.
Purpose of the Study:
- To investigate the association between peak creatine kinase-MB (CK-MB) levels and adverse clinical outcomes following PCI in NSTE ACS patients.
- To determine if post-PCI CK-MB elevation is an independent predictor of short- and medium-term adverse events.
Main Methods:
- Analysis of data from 6164 patients with NSTE ACS across four randomized trials who underwent in-hospital PCI.
- Primary analysis included 2384 patients with CK-MB levels measured within 24 hours post-PCI, excluding those with pre-existing elevated levels.
- Peak CK-MB ratios (level/upper limit of normal) were correlated with in-hospital and 6-month outcomes.
Main Results:
- Higher peak CK-MB ratios post-PCI were significantly associated with increased incidence of in-hospital heart failure, arrhythmias, and cardiogenic shock.
- A dose-response relationship was observed, with greater CK-MB elevation correlating with higher rates of these adverse events.
- The continuous peak CK-MB ratio independently predicted adjusted 6-month mortality (RR 1.06 per unit increase; P=0.017).
Conclusions:
- Elevated peak CK-MB levels after PCI are independently associated with adverse clinical outcomes in NSTE ACS patients.
- These findings highlight the prognostic significance of post-PCI CK-MB elevation in this high-risk cohort.
- Monitoring post-PCI CK-MB levels can aid in risk stratification for NSTE ACS patients.
Aim:
To study the relationship between outcomes and peak creatine kinase (CK)-MB levels after percutaneous coronary intervention (PCI) in patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS).
Methods And Results:
Peak CK-MB ratios (peak CK-MB level/upper limit of normal [ULN]) after PCI were analysed in 6164 patients with NSTE ACS from four randomized trials who underwent in-hospital PCI. We excluded 696 patients with elevated CK or CK-MB levels <24h before PCI; the primary analysis included 2384 of the remaining 5468 patients (43.6%) with CK-MB levels measured <==24h after PCI. The incidence of in-hospital heart failure (0.1%, 0.8%, 3.4%, 4.1%, and 6.1%; P<0.001), arrhythmias (0.8%, 1.9%, 6.9%, 4.1%, and 7.9%; P<0.001), cardiogenic shock (0.1%, 1.3%, 2.0%, 2.3%, and 2.6%; P=0.004), and mortality through 6 months (2.1%, 2.4%, 4.9%, 4.1%, and 5.7%, P=0.005) was increased with peak CK-MB ratios of 0-1, 1-3, 3-5, 5-10, and >10xULN, respectively. The continuous peak CK-MB ratio after PCI significantly predicted adjusted 6-month mortality (risk ratio, 1.06 per unit increase above ULN; 95% confidence interval, 1.01-1.11; P=0.017).
Conclusions:
Greater CK-MB elevation after PCI is independently associated with adverse outcomes in NSTE ACS. These results underscore the adverse implications of elevated CK-MB levels after PCI in this high-risk population.
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