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Visible angiographic complications predict short and long-term outcomes in patients with post-procedural
Paul Fefer1, Amin Daoulah, Bradley H Strauss
1Leviev Hear Center, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv, Israel. paulfefer@gmail.com
Insights
Visible angiographic complications after percutaneous coronary intervention (PCI) significantly worsen patient outcomes. Routine creatine phosphokinase monitoring (CK-MB) may not be necessary if no complications are evident post-PCI.
Area of Science:
- Cardiology
- Interventional Cardiology
- Biomarker Research
Background:
- Elevated cardiac biomarkers post-percutaneous coronary intervention (PCI) indicate increased adverse event risk, but absolute risk remains low.
- A need exists for more specific risk stratification markers following PCI.
Purpose of the Study:
- To determine if visible angiographic complications correlate with patient outcomes in those with elevated post-PCI creatine phosphokinase myocardial band (CK-MB).
Main Methods:
- Patients with elevated post-PCI CK-MB were grouped by presence (n=115) or absence (n=150) of angiographic complications.
- A control group (n=250) without CK-MB elevation was selected from patients undergoing PCI.
- Major adverse cardiac events (MACE) were tracked at 30 days and 1 year.
Main Results:
- Patients with angiographic complications and elevated CK-MB showed significantly worse outcomes (30-day MACE: 8%; 1-year MACE: 26%) compared to those without complications (30-day MACE: 0%; 1-year MACE: 11%) and controls (30-day MACE: 0.4%; 1-year MACE: 11%).
- Biomarker-positive patients without complications had excellent short- and long-term outcomes, similar to biomarker-negative controls (1-year MACE: 11%).
Conclusions:
- Post-PCI patients without visible angiographic complications experience favorable short- and long-term outcomes.
- Routine CK-MB monitoring after PCI may be unnecessary if no clinical symptoms or angiographic complications are present.
Objectives:
To assess whether visible angiographic complication is related to outcome in patients with elevated creatine phosphokinase (CK-MB) following percutaneous coronary intervention (PCI).
Background:
Elevated biomarkers following PCI are associated with increased incidence of adverse events but the absolute risk of such events is low. A more specific marker of risk is needed.
Methods:
Consecutive patients with elevated post-PCI CK-MB were divided into two groups according to presence (n = 115, 43%) or absence (n = 150, 57%) of an angiographic complication. A control group (n = 250) was randomly chosen from 2,403 patients undergoing PCI during the same period without CK-MB elevation. Major adverse cardiac events (MACE) were assessed at 30 days and 1 year.
Results:
Patients with an identifiable angiographic complication and elevated postprocedural CK-MB had significantly worse outcomes at 30 days and 1 year compared with biomarker positive patients without an identifiable complication and control patients (30 day MACE rate: 8% vs 0% vs 0.4%, respectively, p < 0.001; 1 year MACE rate: 26% vs 11% vs 11%, respectively, p = 0.002, all p-values for angiographic complication vs no angiographic complication and for angiographic complication vs control). Biomarker positive patients without identifiable angiographic complication had an excellent short and long term outcome, which was no different from biomarker negative patients (1 year MACE rate: 11% vs 11%, p = 0.53).
Conclusion:
Post-PCI patients without visible angiographic complications have an excellent short and long term outcome. These findings call into question the need for routine CK-MB monitoring after PCI in the absence of clinical symptoms or angiographic complication.
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