title: Association between minor elevations of creatine kinase-MB level and mortality in patients with acute coronary syndromes without ST-segment elevation. PURSUIT Steering Committee. Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy.
abstract: BACKGROUND
  Controversy surrounds the diagnostic and prognostic importance of slightly elevated cardiac markers in patients with acute coronary syndromes without ST-segment elevation.
  
  
  OBJECTIVE
  To investigate the relationship between peak creatine kinase (CK)-MB level and outcome and to determine whether a threshold CK-MB level exists below which risk is not increased.
  
  
  METHODS
  Retrospective observational analysis of data from the international Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy (PURSUIT) trial, conducted from November 1995 to January 1997.
  
  
  METHODS
  A total of 8250 patients with acute coronary syndromes without ST-segment elevation who had at least 1 CK-MB sample collected during their index hospitalization.
  
  
  METHODS
  Mortality at 30 days and 6 months, was assessed by category of index-hospitalization peak CK-MB level (0-1, >1-2, >2-3, >3-5, >5-10, or >10 times the upper limit of normal). Multivariable logistic regression was used to determine the independent prognostic significance of peak CK-MB level after adjustment for baseline predictors of 30-day and 6-month mortality.
  
  
  RESULTS
  Mortality at 30 days and 6 months increased from 1.8% and 4.0%, respectively, in patients with normal peak CK-MB levels, to 3.3% and 6.2 % at peak CK-MB levels 1 to 2 times normal, to 5.1% and 7.5% at peak CK-MB levels 3 to 5 times normal, and to 8.3% and 11.0% at peak CK-MB levels greater than 10 times normal. Log-transformed peak CK-MB levels were predictive of adjusted 30-day and 6-month mortality (P<.001 for both).
  
  
  CONCLUSIONS
  Our data show that elevation of CK-MB level is strongly related to mortality in patients with acute coronary syndromes without ST-segment elevation, and that the increased risk begins with CK-MB levels just above normal. In the appropriate clinical context, even minor CK-MB elevations should be considered indicative of myocardial infarction.
authors.affiliation: Duke Clinical Research Institute, Durham, NC 27715, USA. alexa017@mc.duke.edu
authors.forename: J H
authors.initials: JH
authors.lastname: Alexander
authors.forename: R A
authors.initials: RA
authors.lastname: Sparapani
authors.forename: K W
authors.initials: KW
authors.lastname: Mahaffey
authors.forename: J W
authors.initials: JW
authors.lastname: Deckers
authors.forename: L K
authors.initials: LK
authors.lastname: Newby
authors.forename: E M
authors.initials: EM
authors.lastname: Ohman
authors.forename: R
authors.initials: R
authors.lastname: Corbalán
authors.forename: S L
authors.initials: SL
authors.lastname: Chierchia
authors.forename: J B
authors.initials: JB
authors.lastname: Boland
authors.forename: M L
authors.initials: ML
authors.lastname: Simoons
authors.forename: R M
authors.initials: RM
authors.lastname: Califf
authors.forename: E J
authors.initials: EJ
authors.lastname: Topol
authors.forename: R A
authors.initials: RA
authors.lastname: Harrington
mesh_terms: D000208:Acute Disease; D015415:Biomarkers / Q000097:blood; D003402:Creatine Kinase / Q000097:blood*; D005260:Female; D006801:Humans; D007527:Isoenzymes; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000097:blood / Q000401:mortality; D017202:Myocardial Ischemia / Q000097:blood* / Q000401:mortality*; D011379:Prognosis; D012044:Regression Analysis; D012189:Retrospective Studies
chemical_list: D015415:Biomarkers; D007527:Isoenzymes; D003402:Creatine Kinase