Significance of mild transient release of creatine kinase-MB fraction after percutaneous coronary interventions
A E Abdelmeguid1, E J Topol, P L Whitlow
1Department of Cardiology, Cleveland Clinic Foundation, OH 44195, USA.
Insights
Minor elevations in creatine kinase-myocardial band isoenzyme (CK-MB) after coronary interventions indicate a worse long-term prognosis. Routine measurement of cardiac markers predicts outcomes in patients undergoing percutaneous coronary revascularization.
Area of Science:
- Cardiology
- Biochemistry
- Interventional Cardiology
Background:
- The clinical significance of minor elevations in creatine kinase-myocardial band isoenzyme (CK-MB) post-coronary interventions remains unclear.
- Previous studies have not systematically evaluated the prognostic value of these minor enzyme elevations.
Purpose of the Study:
- To evaluate the clinical significance and long-term prognostic impact of minor CK-MB elevations after successful percutaneous coronary interventions.
- To determine if routine measurement of cardiac biomarkers can predict outcomes in patients undergoing coronary revascularization.
Main Methods:
- A cohort of 4484 patients undergoing successful percutaneous transluminal coronary angioplasty or directional coronary atherectomy was analyzed.
- Patients were categorized into groups based on post-procedure CK and CK-MB levels.
- Cox proportional hazards regression was used for survival analysis, adjusting for potential confounders.
Main Results:
- Minor CK-MB elevations were associated with a higher incidence of cardiac death and myocardial infarction.
- Directional coronary atherectomy and procedural complications were the strongest predictors of CK-MB elevation.
- Major ischemic complications increased with higher CK-MB levels, indicating a worse prognosis.
Conclusions:
- Minor CK-MB elevations after successful coronary interventions identify patients with a significantly worse long-term prognosis.
- Routine measurement of biochemical cardiac markers is recommended as an important predictor of long-term outcomes in percutaneous coronary revascularization studies.
Background:
The clinical significance of minor elevations in creatine kinase-myocardial band isoenzyme (CK-MB) after coronary interventions has not been systematically evaluated.
Methods And Results:
We examined 4484 patients who underwent successful percutaneous transluminal coronary angioplasty or directional coronary atherectomy and whose peak CK levels did not exceed twice the upper limit of laboratory normal. Group 1 (3776 patients) had no CK or MB elevation after the procedure (ie, CK < or = 180 IU/L, with MB fraction < or = 4%). Group 2 (450 patients) had a peak CK level between 100 and 180 IU/L, with MB fraction > 4%, and group 3 (258 patients) had a peak CK level between 181 and 360 IU/L, with MB fraction > 4%. The strongest correlate of postprocedure CK-MB elevation was the performance of directional coronary atherectomy (odds ratio, 4.1; P < .0001), followed by the development of > or = 1 in-1ab minor procedural complication (odds ratio, 2.6; P < .0001). Clinical follow-up was available in 4461 patients (99.5%), with a mean duration of 36 +/- 22 months. Survival analysis, adjusted with Cox proportional hazards regression model, showed that the groups with elevated CK-MB had a significantly higher incidence of cardiac death (risk ratio, 1.3; P = .04) and myocardial infarction (risk ratio, 1.3; P = .03). Major ischemic complications (death, myocardial infarction, and coronary revascularization) occurred more frequently in the groups with increased CK-MB (groups 1 versus 2 versus 3, 37.3% versus 43.3% versus 48.9%; P = .01).
Conclusions:
This study shows that minor elevations of CK-MB after successful coronary interventions identify a population with a worse long-term prognosis compared with patients with no enzyme elevations and appear to have an adverse effect on long-term prognosis. Future studies of percutaneous coronary revascularization should include routine measurements of biochemical cardiac markers as important predictors of long-term prognosis.
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