Creatine kinase-MB enzyme elevation and long-term clinical events after successful coronary stenting in lesions with
Kenichi Fujii1, Stéphane G Carlier, Gary S Mintz
1Cardiovascular Research Foundation, Lenox Hill Heart and Vascular Institute, New York, New York, USA.
Insights
Plaque rupture detected by intravascular ultrasound during coronary stenting is linked to higher creatine kinase-MB (CK-MB) release and increased risks of major adverse cardiac events within one year. This finding highlights the clinical significance of plaque rupture in acute coronary syndrome patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Biomarkers
Background:
- Patients undergoing coronary stent implantation, particularly those with acute coronary syndrome, face elevated risks of periprocedural and long-term adverse events.
- Intravascular ultrasound (IVUS) can identify plaque rupture, a potential factor influencing outcomes after stenting.
Purpose of the Study:
- To investigate the impact of IVUS-detected plaque rupture on creatine kinase-MB (CK-MB) isoenzyme release and 1-year clinical outcomes in patients receiving coronary stents.
- To compare outcomes between patients with and without IVUS-identified plaque rupture.
Main Methods:
- A comparative study involving 62 patients with IVUS-detected plaque rupture and 62 matched controls who underwent coronary stenting.
- Assessment of periprocedural CK-MB isoenzyme release and 1-year composite rates of target lesion revascularization, myocardial infarction, and cardiac death.
- Analysis included patients presenting with acute coronary syndrome.
Main Results:
- Patients with plaque rupture showed significantly higher rates of CK-MB elevation compared to controls (35% vs. 10% for 1-3x ULN, p<0.001; 15% vs. 2% for >3x ULN, p=0.02).
- Independent predictors of CK-MB elevation included plaque rupture (p=0.03) and unstable angina (p=0.04).
- The plaque rupture group experienced higher composite rates of late adverse events (25% vs. 9%, p=0.03).
Conclusions:
- IVUS-detected plaque rupture is associated with increased periprocedural CK-MB release following coronary stenting.
- Plaque rupture independently predicts worse 1-year clinical outcomes in patients treated with coronary stents, including those with acute coronary syndrome.
Abstract:
Patients with acute coronary syndrome are at increased risk of acute and long-term events after stent implantation. We compared the impact of intravascular ultrasound detected plaque rupture on creatine kinase-MB (CK-MB) isoenzyme release and clinical outcomes by comparing 62 patients with ruptured plaques with 62 matched control patients who underwent stent implantation. Two thirds of the patients in each group presented with an acute coronary syndrome. There were no differences in procedural complications between groups, although patients with ruptured plaque had higher CK-MB elevation rates than those without ruptured plaque (1 to 3 times the upper limit of normal CK-MB, 35% vs 10%, p <0.001; >3 times the upper limit, 15% vs 2%, p = 0.02). Independent predictors of CK-MB elevation were presence of ruptured plaque (p = 0.03) and unstable angina (p = 0.04). Patients with ruptured plaque had higher composite rates of late events (target lesion revascularizations/myocardial infarctions/cardiac deaths) than controls (25% vs 9%, p = 0.03). These results were similar when only patients with acute coronary syndrome were studied. Plaque rupture morphology is associated with higher periprocedural CK-MB release and worse 1-year clinical outcome in patients treated with coronary stenting.
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