Creatine kinase is associated with bleeding after myocardial infarction

Area of Science:

• Cardiology
• Biochemistry
• Hematology

Background:

• Creatine kinase (CK) is an enzyme that scavenges ADP.
• Previous research suggests CK can reduce ADP-dependent platelet activation.
• The role of elevated CK in bleeding post-myocardial infarction is unclear.

Purpose of the Study:

• To investigate the association between highly elevated creatine kinase (CK) levels after ST-elevation myocardial infarction (STEMI) and the occurrence of bleeding.
• To determine if peak plasma CK (CKmax) is an independent predictor of bleeding events and mortality.

Main Methods:

• Utilized data from the Thrombolysis in Myocardial Infarction Study Group phase II trial.
• Analyzed patients (n=3339) treated with angioplasty following rt-PA.
• Employed multivariable binomial logistic regression to assess the association between CKmax and bleeding/mortality, adjusting for covariates.

Main Results:

• Adjudicated fatal/non-fatal bleeding occurred in 30% of patients; bleeding/all-cause mortality in 35%.
• Higher CK tertiles were associated with increased bleeding (34% vs 26%) and mortality (40% vs 29%).
• Adjusted odds ratios indicated CKmax increase was associated with bleeding (OR 2.6) and bleeding/mortality (OR 3.1).

Conclusions:

• Highly elevated plasma CK following myocardial infarction may independently predict bleeding and hemorrhagic death.
• The association between extracellular CK and ADP-dependent platelet activation warrants further prospective research.
• This study highlights a potential link between creatine kinase levels and bleeding complications in STEMI patients.