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Published on: May 28, 2019
Prognostic value of creatine kinase-myocardial band isoenzyme elevation following percutaneous coronary intervention:
Jae-Sik Jang1, Han-Young Jin, Jeong-Sook Seo
1Department of Cardiology, Busan Paik Hospital, University of Inje College of Medicine, Busan, Korea.
Insights
Even minor elevations in creatine kinase-myocardial band isoenzyme (CK-MB) after percutaneous coronary intervention (PCI) significantly increase long-term mortality risk. Monitoring these cardiac enzymes post-PCI aids in predicting patient outcomes.
Area of Science:
- Cardiology
- Biomarkers
- Interventional Cardiology
Background:
- While significant cardiac enzyme elevation post-PCI is linked to increased mortality, the impact of minor CK-MB elevations remains unclear.
- Percutaneous coronary intervention (PCI) is a common procedure, making the understanding of post-procedural biomarker changes crucial.
Purpose of the Study:
- To evaluate the association between varying degrees of CK-MB elevation after PCI and subsequent mortality risk.
- To determine if even small increases in CK-MB levels post-PCI have clinical significance.
Main Methods:
- A systematic review and meta-analysis of published literature from January 1999 to October 2011.
- Inclusion of ten studies comprising 48,022 patients undergoing PCI, utilizing risk ratios (RR) for mortality assessment.
Main Results:
- CK-MB elevation greater than 1x the upper limit of normal (ULN) was associated with a 1.74-fold increased risk of mortality.
- A clear dose-response relationship was observed: RR for death was 1.48 (1-3x ULN), 1.71 (3-5x ULN), and 2.83 (≥5x ULN).
Conclusions:
- Even minor elevations in CK-MB levels post-PCI are linked to a significantly higher risk of late mortality.
- Monitoring cardiac enzyme levels after PCI can serve as a valuable tool for predicting long-term clinical outcomes.
Objectives:
To assess whether different degrees of creatine kinase-myocardial band isoenzyme (CK-MB) elevation after percutaneous coronary intervention (PCI) affect the subsequent risk of death.
Background:
While there is consensus that extensive cardiac enzyme elevation increase mortality significantly, there is uncertainty about the exact clinical impact of smaller CK-MB elevations after PCI.
Methods:
The published literature was scanned by formal searches of electronic databases such as PubMed and MEDLINE from January 1999 to October 2011. Risk ratio (RR) was used as summary estimate.
Results:
Ten studies have been included totaling 48,022 patients who underwent PCI (12,246 patients with CK-MB elevation and 35,776 patients without CK-MB elevation). Mean followup duration for each study ranged from 6 to 48 months. CK-MB elevation >1× the upper limit of normal (ULN) conferred a significant increase in the risk of mortality with an overall RR of 1.74 (95% confidence interval [CI], 1.42 to 2.13, P < 0.001). Compared with patients without CK-MB elevation, there was a dose-response relationship with RR for death being 1.48 (95% CI, 1.25-1.77, P < 0.001) with CK-MB elevation 1 to <3× ULN, 1.71 (95% CI, 1.23-2.37, P = 0.001) with CK-MB elevation 3 to 5× ULN, and 2.83 (95% CI, 1.98-4.04, P < 0.001) with CK-MB elevation ≥ 5× ULN.
Conclusions:
Even a small increase in CK-MB levels after PCI is associated with significantly higher risk of late mortality. Monitoring cardiac enzymes after PCI may help predict the long term clinical outcome.
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