Defining the appropriate threshold of creatine kinase elevation after percutaneous coronary interventions

Area of Science:

• Cardiology
• Biomarkers
• Interventional Cardiology

Background:

• Variability exists in defining creatine kinase (CK) elevation thresholds post-coronary interventions.
• Lack of systematic evaluation of prognostic implications of cardiac enzyme elevation hinders consistent interpretation.
• Defining a reliable CK threshold is crucial for assessing adverse clinical outcomes after percutaneous coronary interventions.

Purpose of the Study:

• To evaluate clinical, morphologic, and procedural correlates of CK elevation after percutaneous coronary interventions.
• To assess the long-term follow-up associated with commonly used CK elevation thresholds.
• To define a postprocedural cardiac enzyme level that correlates with adverse clinical outcomes.

Main Methods:

• Analysis of 4664 patients undergoing successful coronary angioplasty or directional atherectomy.
• Categorization into groups based on CK levels: Group I (<= 360 IU/L), Group II (361-900 IU/L), Group III (>900 IU/L with CK-MB >4%).
• Kaplan-Meier survival analysis and Cox proportional hazards regression for long-term follow-up (mean 36 months).

Main Results:

• Cardiac enzyme elevation was associated with specific clinical, morphologic, and procedural factors.
• Elevated CK levels significantly correlated with increased cardiac death (risk ratio 2.19, p < 0.0001).
• Patients with elevated CK showed a higher incidence of cardiac death compared to the control group (p < 0.0001).

Conclusions:

• Creatine kinase elevations between 2 and 5 times the upper limit of normal after coronary interventions are linked to adverse long-term outcomes.
• A CK threshold of twice the upper limit of normal appears to have significant prognostic implications.
• These findings support establishing a standardized CK elevation threshold for risk stratification post-coronary interventions.