Incidence, predictors, and significance of abnormal cardiac enzyme rise in patients treated with bypass surgery in the arterial revascularization therapies study (ARTS).
BACKGROUND
Although it has been suggested that elevation of CK-MB after percutaneous coronary intervention is associated with adverse clinical outcomes, limited data are available in the setting of coronary bypass grafting. The aim of the present study was to determine the incidence, predictors, and prognostic significance of CK-MB elevation following multivessel coronary bypass grafting (CABG).


RESULTS
The population comprises 496 patients with multivessel coronary disease assigned to CABG in the Arterial Revascularization Therapies Study (ARTS). CK-MB was prospectively measured at 6, 12, and 18 hours after the procedure. Thirty-day and 1-year clinical follow-up were performed. Abnormal CK-MB elevation occurred in 61.9% of the patients. Patients with increased cardiac-enzyme levels after CABG were at increased risk of both death and repeat myocardial infarction within the first 30 days (P=0.001). CK-MB elevation was also independently related to late adverse outcome (P=0.009, OR=0.64).


CONCLUSIONS
Increased concentrations of CK-MB, which are often dismissed as inconsequential in the setting of multivessel CABG, appear to occur very frequently and are associated with a significant increase in both repeat myocardial infarction and death beyond the immediate perioperative period.
Costa
M A
MA
University Hospital Dijkzigt, Thoraxcentrum, Rotterdam, the Netherlands.
Carere
R G
RG
Lichtenstein
S V
SV
Foley
D P
DP
de Valk
V
V
Lindenboom
W
W
Roose
P C
PC
van Geldorp
T R
TR
Macaya
C
C
Castanon
J L
JL
Fernandez-Avilèz
F
F
Gonzáles
J H
JH
Heyer
G
G
Unger
F
F
Serruys
P W
PW
D015415:Biomarkers / Q000097:blood; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D003327:Coronary Disease / Q000097:blood* / Q000401:mortality / Q000601:surgery; D003402:Creatine Kinase / Q000097:blood*; D052279:Creatine Kinase, MB Form; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007527:Isoenzymes / Q000097:blood*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D016017:Odds Ratio; D011184:Postoperative Period; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D015996:Survival Rate
D015415:Biomarkers; D007527:Isoenzymes; D003402:Creatine Kinase; D052279:Creatine Kinase, MB Form