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Prognostic Implications of Creatine Kinase-MB Elevation After Percutaneous Coronary Intervention
- Source :
- Circulation: Cardiovascular Interventions. 4:474-480
- Publication Year :
- 2011
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2011.
-
Abstract
- Background— Creatine kinase-MB (CK-MB) elevation after percutaneous coronary intervention (PCI) has been associated with increased risk for mortality. Although most studies have defined periprocedural myocardial infarction (pMI) as an elevation in CK-MB >3× upper limit of normal (ULN), use of different CK-MB assays and variation in site-specific definitions of the ULN may limit the value of such relative thresholds. Methods and Results— We used data from the multicenter Evaluation of Drug-Eluting Stents and Ischemic Events (EVENT) registry to examine the impact of variations in site-specific thresholds for CK-MB elevation on the incidence of pMI as well as the relationship between absolute peak levels of CK-MB after PCI and 1-year mortality. The study cohort consisted of 6347 patients who underwent nonemergent PCI and had normal CK-MB at baseline. Across the 59 study centers, the ULN for CK-MB ranged from 2.6 to 10.4 ng/mL (median, 5.0 ng/mL), and there was an inverse relationship between the site-specific ULN and the incidence of pMI (defined as CK-MB elevation >3× ULN). Although any postprocedure elevation of CK-MB was associated with an adverse prognosis, in categorical analyses, only CK-MB ≥50 ng/mL was independently associated with increased 1-year mortality (hazard ratio, 4.71; 95% confidence interval, 2.42 to 9.13; P Conclusions— Among unselected patients undergoing PCI, there is a graded relationship between CK-MB elevation after PCI and 1-year mortality that is particularly strong for large CK-MB elevations (>30 to 50 ng/mL). Future studies that include pMI as a clinical end point should consider using a core laboratory to assess CK-MB (to ensure consistency) and raising the threshold for defining pMI above current levels (to enhance clinical relevance).
- Subjects :
- Male
medicine.medical_specialty
medicine.medical_treatment
Myocardial Infarction
Coronary Artery Disease
Cohort Studies
Postoperative Complications
Recurrence
Reference Values
Risk Factors
Internal medicine
Angioplasty
medicine
Creatine Kinase, MB Form
Humans
Myocardial infarction
Survival analysis
Aged
biology
business.industry
Percutaneous coronary intervention
Drug-Eluting Stents
Middle Aged
Prognosis
medicine.disease
Survival Analysis
Surgery
Conventional PCI
Cohort
Cardiology
biology.protein
Female
Creatine kinase
Cardiology and Cardiovascular Medicine
business
Follow-Up Studies
Cohort study
Subjects
Details
- ISSN :
- 19417632 and 19417640
- Volume :
- 4
- Database :
- OpenAIRE
- Journal :
- Circulation: Cardiovascular Interventions
- Accession number :
- edsair.doi.dedup.....dc838656f59da033ff1f3a61f682ec8b