Creatine kinase-MB elevation after percutaneous coronary intervention predicts adverse outcomes in patients with acute coronary syndromes

Matthew T. Roe, K. W. Mahaffey, R. Kilaru, J. H. Alexander, K. M. Akkerhuis, M. L. Simoons, R. A. Harrington, B. E. Tardiff, C. B. Granger, E. M. Ohman, D. J. Moliterno, A. M. Lincoff, P. W. Armstrong, F. Van De Werf, R. M. Califf, E. J. Topol

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61 Scopus citations

Abstract

Aim: To study the relationship between outcomes and peak creatine kinase (CK)-MB levels after percutaneous coronary intervention (PCI) in patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS). Methods and results: Peak CK-MB ratios (peak CK-MB level/upper limit of normal [ULN]) after PCI were analysed in 6164 patients with NSTE ACS from four randomized trials who underwent in-hospital PCI. We excluded 696 patients with elevated CK or CK-MB levels <24 h before PCI; the primary analysis included 2384 of the remaining 5468 patients (43.6%) with CK-MB levels measured <24 h after PCI. The incidence of in-hospital heart failure (0.1%, 0.8%, 3.4%, 4.1%, and 6.1%; P<0.001), arrhythmias (0.8%, 1.9%, 6.9%, 4.1%, and 7.9%; P<0.001), cardiogenic shock (0.1%, 1.3%, 2.0%, 2.3%, and 2.6%; P=0.004), and mortality through 6 months (2.1%, 2.4%, 4.9%, 4.1%, and 5.7%, P=0.005) was increased with peak CK-MB ratios of 0-1, 1-3, 3-5, 5-10, and >10×ULN, respectively. The continuous peak CK-MB ratio after PCI significantly predicted adjusted 6-month mortality (risk ratio, 1.06 per unit increase above ULN; 95% confidence interval, 1.01-1.11; P=0.017). Conclusions: Greater CK-MB elevation after PCI is independently associated with adverse outcomes in NSTE ACS. These results underscore the adverse implications of elevated CK-MB levels after PCI in this high-risk population.

Original languageEnglish
Pages (from-to)313-321
Number of pages9
JournalEuropean Heart Journal
Volume25
Issue number4
DOIs
StatePublished - Feb 2004

Keywords

  • Acute coronary syndromes
  • Biomarkers
  • Creatine kinase
  • Percutaneous coronary interventions
  • Prognosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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