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Impact of periprocedural creatine kinase-MB isoenzyme release on long-term mortality in contemporary percutaneous
Mohammed Andron1, Rodney H Stables, Mohaned Egred
1Cardiology Department, Cardiothoracic Centre, Thomas Drive, Liverpool, L14 3PE, United Kingdom. mohammedandron@blueyonder.co.uk
Insights
Periprocedural creatine kinase-MB (CK-MB) release after percutaneous coronary intervention (PCI) is common and significantly increases long-term mortality risk. Elevated CK-MB levels indicate myonecrosis, a predictor of poorer outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Biomarkers
Background:
- Percutaneous coronary intervention (PCI) is a common procedure for treating coronary artery disease.
- Assessing periprocedural myocardial injury is crucial for patient outcomes.
Purpose of the Study:
- To determine the incidence of creatine kinase-MB (CK-MB) release following PCI.
- To evaluate the association between periprocedural CK-MB elevation and long-term mortality.
Main Methods:
- Retrospective analysis of 3,864 patients undergoing PCI with stent deployment.
- Exclusion of patients with ST-elevation myocardial infarction, cardiogenic shock, or missing CK-MB data.
- Cox proportional hazards analysis to assess the relationship between CK-MB levels and all-cause mortality.
Main Results:
- 29.4% of patients exhibited elevated CK-MB levels above the upper limit of normal (ULN).
- Periprocedural CK-MB elevation was independently associated with increased risk of death (aHR 1.09 per 10 units).
- Higher CK-MB levels correlated with significantly greater mortality risk (aHRs 1.30, 1.76, and 2.26 for increasing strata).
Conclusions:
- Periprocedural myonecrosis, indicated by CK-MB elevation, is frequent in contemporary PCI.
- Elevated CK-MB levels are linked to unfavorable long-term mortality following PCI.
Objective:
To evaluate the incidence of periprocedural creatine kinase-MB (CK-MB) release and its impact on longterm mortality in contemporary percutaneous coronary intervention (PCI) at a tertiary referral center.
Methods:
Retrospective analysis of 4,958 patients undergoing PCI with deployment of at least 1 stent at our center between January 1, 2003 and December 31, 2005. Patients admitted with acute ST-elevation myocardial infarction or cardiogenic shock (n = 617), and patients with no available CK-MB levels (n = 477) were excluded, leaving 3,864 patients for analysis. The outcome measure was all-cause mortality obtained from the National Strategic Tracing Service with patients followed up to June 30, 2006 (mean follow up 22 months). The association between CK-MB level and mortality was examined using Cox proportional hazards analysis.
Results:
CK-MB elevation above the upper limit of normal (ULN) was detected in 29.4% patients. A total of 127 deaths were observed during follow up. By multivariate analysis, periprocedural CK-MB was independently associated with an increased risk of death (adjusted hazard ratio for every 10 units: 1.09; 95% CI: 1.05-1.12; p < 0.001). The relationship between the level of CK-MB and mortality was further examined by applying strata of CK-MB levels to the multivariate analysis (adjusted hazard ratio: 1.30, 1.76 and 2.26 for CK-MB levels of 1-3, 3-5 and > 5 the ULN, respectively).
Conclusion:
In the current era of PCI, periprocedural myonecrosis, evidenced by CK-MB elevation, is common and is associated with less favorable long-term mortality.
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