Minimal myocardial damage during coronary intervention is associated with impaired outcome.
OBJECTIVE
Studies on the glycoprotein IIb-IIIa receptor blocker abciximab in patients undergoing percutaneous coronary intervention consistently show a reduction in procedure-related myocardial infarction. Some such infarcts are characterized by elevated creatine kinase or creatine kinase-MB, without apparent clinical symptoms. The clinical relevance of such 'creatine kinase leaks' has been questioned. Therefore we investigated the relationship between post-procedural creatine kinase-MB elevation and outcome at the 6 month follow-up.


RESULTS
Creatine kinase-MB, or total creatine kinase values were analysed in 5025 out of 6156 patients enrolled in the CAPTURE, EPIC and EPILOG studies. A consistent gradual increase in 6 month mortality was observed as creatine kinase-MB or creatine kinase levels increased: 1.1%, 2.1%, 1.8%, 3. 6% and 6.7% for creatine-MB or creatine ratios (relative to upper limit of normal) <1, 1-3, 3-5, 5-10 and >/=10, respectively. Also the incidence of death or (recurrent) myocardial infarction was related to creatine kinase-MB or creatine kinase ratios. Subsequent revascularization was not related to periprocedural myocardial infarction. By multivariable analysis, correcting for clinical and angiographic characteristics, mortality at 6 months was related to the enzyme (creatine kinase, creatine kinase-MB) ratio, a history of heart failure and age. The combined end-point of death and myocardial infarction was also related to these factors, as well as to a history of bypass surgery and unstable angina.


CONCLUSIONS
Modest elevation of cardiac enzymes (creatine kinase-MB, creatine kinase) after percutaneous coronary intervention is associated with an increased risk of mortality and reinfarction during the 6 month follow-up. Measures to reduce such periprocedural infarcts are warranted.
Simoons
M L
ML
Thoraxcenter, Rotterdam, The Netherlands.
van den Brand
M
M
Lincoff
M
M
Harrington
R
R
van der Wieken
R
R
Vahanian
A
A
Rutsch
W
W
Kootstra
J
J
Boersma
E
E
Califf
R M
RM
Topol
E
E
D000077284:Abciximab; D015906:Angioplasty, Balloon, Coronary; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D003402:Creatine Kinase / Q000097:blood*; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use; D007527:Isoenzymes; D009203:Myocardial Infarction / Q000188:drug therapy / Q000201:enzymology* / Q000401:mortality / Q000628:therapy*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012008:Recurrence; D016019:Survival Analysis; D016896:Treatment Outcome
D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D007527:Isoenzymes; D010975:Platelet Aggregation Inhibitors; D003402:Creatine Kinase; D000077284:Abciximab