Creatine kinase during non-ST-segment elevation acute coronary syndromes is associated with major bleeding

Area of Science:

• Cardiology
• Biochemistry
• Clinical Medicine

Background:

• Previous research linked highly elevated creatine kinase (CK) to bleeding in ST-segment elevation myocardial infarction.
• Creatine kinase (CK) is an enzyme that scavenges ADP and may attenuate platelet aggregation.

Purpose of the Study:

• To investigate if moderately elevated CK in non-ST-segment elevation acute coronary syndrome (NSTE-ACS) is associated with major bleeding.
• To assess the association of peak plasma CK (CKmax) with major bleeding and a composite outcome in NSTE-ACS patients.

Main Methods:

• Analysis of data from the Thrombolysis In Myocardial Ischemia (TIMI) 3B trial.
• Examined the independent association of peak plasma CK (CKmax) with major bleeding and a composite outcome (bleeding, stroke, death).
• Adjusted for covariables including age, sex, BMI, blood pressure, creatinine, and thrombolytic therapy use.

Main Results:

• Major bleeding occurred in 2.0% of patients (mean CKmax 1015 IU/L, six times URL).
• Adjusted odds ratios per log CK increase were 3.1 for major bleeding and 3.9 for the composite outcome.
• The association between CK and bleeding was independent of thrombolytic therapy use.

Conclusions:

• Elevated plasma CK activity is strongly and independently associated with major bleeding in NSTE-ACS patients.
• CK may enhance the accuracy of bleeding prediction models for NSTE-ACS.
• Findings support previous evidence on CK's role in bleeding risk.