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Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Prognostic implications of creatine kinase-MB measurements in ST-segment elevation myocardial infarction patients
Akshay Bagai1, Phillip J Schulte2, Christopher B Granger2
1St. Michael's Hospital, University of Toronto, Ontario, Canada.
Insights
Peak creatine kinase-MB (CK-MB) levels and their area under the curve predict cardiovascular outcomes in ST-elevation myocardial infarction patients treated with primary percutaneous coronary intervention. These measurements are valuable for assessing treatment efficacy.
Area of Science:
- Cardiology
- Biomarker Research
- Clinical Outcomes
Background:
- Peak creatine kinase-MB (CK-MB) concentration correlates with reperfusion success and outcomes in acute myocardial infarction treated with fibrinolysis.
- Prognostic value of CK-MB after primary percutaneous coronary intervention (PCI) remains unclear.
Purpose of the Study:
- To investigate the prognostic implications of peak CK-MB concentration and area under the time-concentration curve (AUC) in patients undergoing primary PCI for ST-elevation myocardial infarction (STEMI).
Main Methods:
- Pooled data from 3 trials involving 2,042 primary PCI-treated STEMI patients.
- Analyzed serial CK-MB measurements in 1,799 survivors with at least 4 measurements.
- Used Cox regression to assess associations between peak CK-MB/AUC and 6-month mortality or 90-day death/congestive heart failure.
Main Results:
- Median peak CK-MB was 239 ng/mL; median AUC through 36 hours was 4,263 ng/(mL h).
- Peak CK-MB and AUC were independently associated with increased 6-month mortality.
- Both markers also independently predicted 90-day death or congestive heart failure.
Conclusions:
- Peak CK-MB concentration and AUC are independent predictors of cardiovascular outcomes at 3-6 months post-primary PCI in STEMI patients.
- These biomarkers can serve as efficacy endpoints in early-phase STEMI therapy trials.
Background:
Peak creatine kinase (CK)-MB concentration is related to reperfusion success and clinical outcomes after fibrinolytic therapy for acute myocardial infarction. However, prognostic implications of CK-MB measurements after primary percutaneous coronary intervention (PCI), which provides more predictable and consistent reperfusion, are unknown.
Methods:
We pooled 2,042 primary PCI-treated ST-segment elevation myocardial infarction (STEMI) patients from 3 trials with serial core laboratory-determined CK-MB measurements; 1,799 patients (88.1%) who survived to 36 hours and had ≥4 CK-MB measurements were studied. Cox regression modeling was performed to quantify the association between peak CK-MB concentration (and area under the time-concentration curve [AUC]) and mortality at 6 months, and death or congestive heart failure at 90 days.
Results:
The median (25th-75th percentiles) peak CK-MB concentration and AUC measurement through 36 hours were 239 (109-429) ng/mL and 4,263 (2,081-7,124) ng/(mL h), respectively. By multivariable analysis, peak CK-MB concentration and AUC measurement were independently associated with 6-month mortality (adjusted hazard ratio [HR] 1.15, 95% CI 1.05-1.25, per 100-ng/mL increase, P = .002; and adjusted HR 1.09, 95% CI 1.03-1.14, per 1,000-ng/[mL h] increase, P < .001, respectively) and 90-day death or congestive heart failure (adjusted HR 1.26, 95% CI 1.18-1.34, P < .001; and adjusted HR 1.15, 95% CI 1.11-1.19, P < .001, respectively).
Conclusions:
Peak CK-MB concentration and AUC measurement are independent predictors of 3- to 6-month cardiovascular outcomes in primary PCI-treated STEMI patients. Our findings guide application of these measurements as efficacy end points in early-phase studies evaluating new therapies for STEMI.
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