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Creatine kinase release after successful percutaneous transluminal coronary angioplasty
Insights
Mild creatine kinase MB isoenzyme (CK-MB) elevation after successful percutaneous transluminal coronary angioplasty (PTCA) is common. This enzyme release is not linked to worse outcomes, suggesting routine monitoring may be unnecessary.
Area of Science:
- Cardiology
- Biochemistry
Background:
- Percutaneous transluminal coronary angioplasty (PTCA) is a common procedure for coronary artery disease.
- Assessing myocardial injury post-PTCA is crucial for patient management.
Purpose of the Study:
- To determine the incidence and clinical significance of creatine kinase MB isoenzyme (CK-MB) elevation after successful PTCA.
- To identify factors associated with CK-MB release post-PTCA.
Main Methods:
- Prospective study of 128 patients undergoing successful PTCA.
- Measurement of CK-MB levels post-procedure.
- Correlation of enzyme elevation with clinical variables and patient outcomes.
Main Results:
- 20% of patients showed mild CK-MB elevation post-PTCA.
- Chest pain, small branch vessel occlusion, and recent myocardial infarction were associated with CK-MB elevation.
- No increased cardiac morbidity or mortality was observed in patients with CK-MB elevation.
Conclusions:
- Mild CK-MB elevation after successful PTCA is likely due to minor myocardial necrosis and not indicative of significant cardiac events.
- Routine serial enzyme determinations and prolonged hospitalization are likely unnecessary for patients with isolated CK-MB elevation post-PTCA.
- Optimizing PTCA protocols by reducing unnecessary tests can improve cost-effectiveness.
Abstract:
After successful percutaneous transluminal coronary angioplasty (PTCA), 25 (20%) of 128 patients had elevation of creatine kinase MB isoenzyme (CK-MB). The increase was mild (mean 9% MB with total creatine kinase of 179 U/L). Three variables were significantly related to the enzyme elevation: chest pain, small branch vessel occlusion, and recent myocardial infarction. Of the patients with CK-MB elevation, 60% experienced chest pain and 32% sustained a small branch vessel occlusion during PTCA, compared with 11% and 8%, respectively, of the 103 patients without enzyme elevation (p less than 0.001 and p less than 0.01). Of 16 patients with recent myocardial infarction, seven (44%) had release of CK-MB. Although mild enzyme elevation after successful PTCA is likely due to a small amount of myocardial necrosis, this phenomenon was not associated with increased cardiac morbidity or mortality. Therefore, release of CK-MB without other clinical evidence for myocardial infarction after successful PTCA does not in itself warrant longer hospitalization, and routine serial enzyme determinations are probably unnecessary. By reducing the number of laboratory tests and the duration of hospitalization, the cost effectiveness of PTCA may be increased.