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Significance of mild transient release of creatine kinase-MB fraction after percutaneous coronary interventions.

Abstract：

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.

journal_name

Circulation

journal_title

Circulation

authors

Abdelmeguid AE,Topol EJ,Whitlow PL,Sapp SK,Ellis SG

doi

10.1161/01.cir.94.7.1528

subject

Has Abstract

pub_date

1996-10-01 00:00:00

pages

1528-36

issue

eissn

0009-7322

issn

1524-4539

journal_volume

pub_type

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Significance of mild transient release of creatine kinase-MB fraction after percutaneous coronary interventions.