title: Long-term clinical events following creatine kinase--myocardial band isoenzyme elevation after successful coronary stenting.
abstract: OBJECTIVE
  We sought to evaluate the impact of intermediate creatine kinase-myocardial band isoenzyme (CK-MB) elevation on late clinical outcomes in patients undergoing successful stent implantation in native coronary arteries.
  
  
  BACKGROUND
  Elevations of CK-MB after percutaneous coronary interventions are frequent. An association between high level of CK-MB elevation (>5 times normal) and late mortality after balloon and new device angioplasty has been reported previously. However, significant controversy remains on the long-term clinical importance of lower CK-MB elevations (one to five times normal) after percutaneous coronary revascularization. Moreover, the incidence and prognostic importance of cardiac enzyme elevation after coronary stenting have not been well established.
  
  
  METHODS
  Prospectively collected data from 900 consecutive patients (1,213 lesions) undergoing successful stenting in native vessels were analyzed. Based on the CK-MB levels after coronary stenting, patients were classified into three groups: normal group 1 (n = 585), elevation of >1 to 5 times normal group 2 (n = 238) and elevation of >5 times normal group 3 (n = 77).
  
  
  RESULTS
  Patients in group 3 had more in-hospital recurrent ischemia (p = 0.001) and pulmonary edema (p = 0.01) than patients in groups 1 and 2. Long-term clinical end points were similar between groups 1 and 2. However, patients in group 3 had an increased incidence of late mortality compared with patients in groups 2 and 1 (6.9%, 1.2% and 1.7%, respectively, p = 0.01). Multivariate analysis showed that patients with CK-MB >5 times normal after coronary stenting had an increased risk of major adverse clinical events (relative risk: 1.70, p < 0.05) and death (relative risk: 3.25, p < 0.05) that was not observed in patients with lower CK-MB rise.
  
  
  CONCLUSIONS
  Patients with CK-MB elevation >5 times normal had higher late mortality and more unfavorable event-free survival than those patients with normal or lower CK-MB rise after coronary stenting. While intermediate CK-MB elevation (>1 to 5 times normal) is frequent after coronary stenting (26%), this was not associated with an increased risk of late mortality or major adverse clinical events.
authors.affiliation: Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, USA.
authors.forename: J F
authors.initials: JF
authors.lastname: Saucedo
authors.forename: R
authors.initials: R
authors.lastname: Mehran
authors.forename: G
authors.initials: G
authors.lastname: Dangas
authors.forename: M K
authors.initials: MK
authors.lastname: Hong
authors.forename: A
authors.initials: A
authors.lastname: Lansky
authors.forename: K M
authors.initials: KM
authors.lastname: Kent
authors.forename: L F
authors.initials: LF
authors.lastname: Satler
authors.forename: A D
authors.initials: AD
authors.lastname: Pichard
authors.forename: G W
authors.initials: GW
authors.lastname: Stone
authors.forename: M B
authors.initials: MB
authors.lastname: Leon
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000295:instrumentation*; D015415:Biomarkers / Q000097:blood; D003327:Coronary Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000201:enzymology* / Q000401:mortality / Q000628:therapy*; D003402:Creatine Kinase / Q000097:blood*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D011654:Pulmonary Edema / Q000209:etiology; D011859:Radiography; D012008:Recurrence; D012307:Risk Factors; D012720:Severity of Illness Index; D015607:Stents / Q000009:adverse effects*; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D003402:Creatine Kinase