title: Creatine kinase-MB elevation after coronary intervention correlates with diffuse atherosclerosis, and low-to-medium level elevation has a benign clinical course: implications for early discharge after coronary intervention.
abstract: OBJECTIVE
  The study evaluated the incidence and predictors of creatine kinase-MB isoenzyme (CK-MB) elevation after successful coronary intervention using current devices, and assessed the influence on in-hospital course and midterm survival.
  
  
  BACKGROUND
  The CK-MB elevation after coronary intervention predominantly using balloon angioplasty correlates with late cardiac events of myocardial infarction (MI) and death. Whether CK-MB elevation after nonballoon devices is associated with an adverse short and midterm prognosis is unknown.
  
  
  METHODS
  The incidence and predictors of CK-MB elevation after coronary intervention were prospectively studied in 1,675 consecutive patients and were followed for in-hospital events and survival.
  
  
  RESULTS
  CK-MB elevation was detected in 313 patients (18.7%), with 1-3x in 12.8%, 3-5x in 3.5% and >5x normal in 2.4% of patients. Procedural complications or electrocardiogram changes occurred in only 49% of the CK-MB-elevation cases; CK-MB elevation was more common after nonballoon devices (19.5% vs. 11.5% after percutaneous transluminal coronary angioplasty; p < 0.01). Predictors of CK-MB elevation on multivariate analysis were diffuse coronary disease (p = 0.02), systemic atherosclerosis (p = 0.002), stent use (p = 0.04) and absence of beta-blocker therapy (p = 0.001). Adverse in-hospital cardiac events were more frequent in patients with >5x CK-MB elevation, with no significant difference between 1-5x CK-MB elevation versus normal CK-MB group. During a mean follow-up of 13 +/- 3 months, the incidence of death in the CK-MB-elevation group was 1.6% versus 1.3% in the normal CK-MB group (p = NS).
  
  
  CONCLUSIONS
  The CK-MB elevation after coronary intervention was observed even in the absence of discernible procedural complications and was more common in patients with diffuse atherosclerosis. In-hospital clinical events requiring prolonged monitoring were higher in >5x CK-MB-elevation patients only. Midterm survival of CK-MB-elevation patients was similar to those with normal CK-MB. Our prospective analysis shows a lack of adverse in-hospital cardiac events and suggests that early discharge of stable 1-5x normal CK-MB-elevation patients after successful coronary intervention is safe.
authors.affiliation: Cardiac Catheterization Laboratory of the Zena and Michael A. Weiner Cardiovascular Institute, Mount Sinai Hospital, New York, New York 10029-6574, USA.
authors.forename: A
authors.initials: A
authors.lastname: Kini
authors.forename: J D
authors.initials: JD
authors.lastname: Marmur
authors.forename: S
authors.initials: S
authors.lastname: Kini
authors.forename: G
authors.initials: G
authors.lastname: Dangas
authors.forename: T P
authors.initials: TP
authors.lastname: Cocke
authors.forename: S
authors.initials: S
authors.lastname: Wallenstein
authors.forename: E
authors.initials: E
authors.lastname: Brown
authors.forename: J A
authors.initials: JA
authors.lastname: Ambrose
authors.forename: S K
authors.initials: SK
authors.lastname: Sharma
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D017225:Atherectomy, Coronary / Q000009:adverse effects; D004796:Clinical Enzyme Tests / Q000706:statistics & numerical data; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D003402:Creatine Kinase / Q000097:blood*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007527:Isoenzymes; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010351:Patient Discharge; D011379:Prognosis; D011446:Prospective Studies; D012449:Safety; D015607:Stents; D013997:Time Factors
chemical_list: D007527:Isoenzymes; D003402:Creatine Kinase