title: Elevation of the creatine kinase myocardial isoform following otherwise successful directional coronary atherectomy and stenting.
abstract: Moderate elevation of creatine kinase (CK) MB isoform is common following otherwise successful percutaneous coronary revascularization, and is frequently interpreted as evidence of a non-Q-wave myocardial infarction. It is not clear, however, whether elevation of CK MB isoform carries sufficient adverse clinical impact to be categorized as a "major" complication. We therefore explored the incidence and clinical consequence of elevation of CK MB isoform in a consecutive series of 565 patients who had otherwise successful directional coronary atherectomy (n = 274) or stenting (n = 291), and were followed for a mean of 2 years. Of this cohort, 11.5% had postprocedure elevation of the CK MB isoform above normal (10 IU/liter). These patients tended to be older and to have undergone atherectomy of a de novo lesion with adverse morphology (thrombus, calcification, eccentricity). Patients with elevation of CK MB isoform following otherwise successful revascularization generally showed no adverse long-term sequelae (death, recurrent myocardial infarction, repeat revascularization) compared with patients without elevation of CK MB isoform. Only 2.3% of the patients who had CK MB isoform release > 50 IU/liter demonstrated a trend (p = 0.08) toward decreased late survival, compared with patients without CK MB isoform elevation. While minor CK MB isoform elevation is common (11.5%) after successful coronary stenting or directional atherectomy, it generally has no adverse clinical consequences, and should not be considered a major complication.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Charles A. Dana Research Institute, Boston, Massachusetts.
authors.forename: A D
authors.initials: AD
authors.lastname: Kugelmass
authors.forename: D J
authors.initials: DJ
authors.lastname: Cohen
authors.forename: M
authors.initials: M
authors.lastname: Moscucci
authors.forename: R N
authors.initials: RN
authors.lastname: Piana
authors.forename: C
authors.initials: C
authors.lastname: Senerchia
authors.forename: R E
authors.initials: RE
authors.lastname: Kuntz
authors.forename: D S
authors.initials: DS
authors.lastname: Baim
mesh_terms: D000368:Aged; D017225:Atherectomy, Coronary / Q000401:mortality; D003327:Coronary Disease / Q000097:blood / Q000401:mortality / Q000601:surgery; D003402:Creatine Kinase / Q000097:blood*; D005260:Female; D006801:Humans; D007527:Isoenzymes; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects*; D016019:Survival Analysis
chemical_list: D007527:Isoenzymes; D003402:Creatine Kinase