Related Experiment Video
Updated: Aug 11, 2026
Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Prognostic implications of creatine kinase elevation after primary percutaneous coronary intervention for acute
Amir Halkin1, Gregg W Stone, Cindy L Grines
1Cardiovascular Research Foundation, New York, New York 10022, USA.
Insights
Peak creatine kinase (CK) levels after primary percutaneous coronary intervention (PCI) predict one-year mortality. Higher CK levels indicate increased risk, independent of other factors, highlighting CK
Area of Science:
- Cardiology
- Biomarkers
- Clinical Outcomes
Background:
- Creatine kinase (CK) levels and their rate of increase are linked to outcomes after thrombolytic therapy for acute myocardial infarction (AMI).
- The prognostic value of routine CK monitoring after primary percutaneous coronary intervention (PCI) is not well-established.
Purpose of the Study:
- To investigate the prognostic significance of absolute creatine kinase (CK) levels and their rate of increase following primary PCI.
- To determine if CK monitoring adds predictive value beyond established markers.
Main Methods:
- Analysis of 1,529 patients from the Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) trial.
- Serial CK measurements were taken at baseline and at 8, 16, and 24 hours post-PCI.
- Multivariate analysis assessed CK levels as predictors of one-year mortality and myocardial recovery.
Main Results:
- Peak CK (CK(peak)) occurred within 24 hours post-PCI in most patients.
- Higher CK levels at all post-PCI time points, including CK(peak), were associated with increased one-year mortality.
- CK(peak) was a significant independent predictor of one-year mortality (HR=2.15, p=0.0002) and inversely correlated with left ventricular ejection fraction recovery.
Conclusions:
- Peak creatine kinase (CK) levels after primary percutaneous coronary intervention (PCI) are a potent predictor of one-year mortality.
- CK(peak) provides prognostic information independent of other clinical and angiographic factors.
- Routine CK monitoring after primary PCI may improve risk stratification for patients with acute myocardial infarction (AMI).
Objectives:
We examined the prognostic implications of the absolute level and rate of increase of creatine kinase (CK) elevation after primary percutaneous coronary intervention (PCI).
Background:
Peak creatine kinase (CK(peak)) and the rate of CK increase are related to reperfusion success and clinical outcomes after thrombolytic therapy for acute myocardial infarction (AMI). The utility of routine serial CK monitoring after primary PCI, in which normal antegrade blood flow is restored in most patients, is unknown.
Methods:
In the Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) trial, 1,529 patients with AMI randomized to either stenting or balloon angioplasty, each with or without abciximab, had CK levels determined at baseline and at 8 +/- 1 h, 16 +/- 1 h, and 24 +/- 1 h after PCI.
Results:
The CK(peak) occurred at baseline in 3.9% of patients, at 8 +/- 1 h in 69.6%, at 16 +/- 1 h in 20.0%, and at 24 +/- 1 h in 6.5%. The CK levels at all post-procedural time points were significantly higher in patients who died compared with the one-year survivors, as was CK(peak) (mean, 2,865 U/l vs. 1,885 U/l, respectively, p < or = 0.001). By multivariate analysis, CK(peak) was a significant predictor of one-year mortality (hazard ratio = 2.15, p = 0.0002), independent from post-PCI Thrombolysis In Myocardial Infarction (TIMI) flow. Both the improvement in left ventricular ejection fraction from baseline to seven months and its absolute level were inversely correlated with CK(peak) (p < 0.001 for both). In contrast, the time to CK(peak) was not an independent predictor of mortality or myocardial recovery.
Conclusions:
The CK(peak) after primary PCI is a powerful predictor of one-year mortality independent of other clinical and angiographic measures.
Related Concept Videos
01:20Blood Studies for Cardiovascular System I: Cardiac Biomarkers
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
Troponins
Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:30Acute Coronary Syndrome I: Introduction
01:29Acute Kidney Injury III: Clinical Manifestations
01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention
01:22Acute Kidney Injury I: Introduction