Association between CK-MB elevation after percutaneous or surgical revascularization and three-year mortality.
OBJECTIVE
The goal of this study was to assess the long-term impact of creatine kinase-MB isoform (CK-MB) elevation after percutaneous or surgical revascularization.


BACKGROUND
The long-term impact of CK-MB elevation after coronary artery bypass grafting (CABG) is not as well characterized as that following percutaneous coronary intervention (PCI).


METHODS
The three-year cumulative survival of consecutive patients who underwent their first percutaneous or surgical revascularization procedure between January 1, 1995 and August 31, 2000 and had CK-MB determination was assessed using the Social Security Death Index.


RESULTS
The 3,812 patients undergoing CABG had a less favorable coronary risk profile than the 3,573 patients undergoing PCI. The incidence of CK-MB elevation above normal range was 90% and 38% for the CABG and PCI groups (p < 0.001). In 6% and 5%, respectively, the elevation surpassed 10x the upper limit of normal (ULN). At an average follow-up of three years, there were 712 deaths, 83 of which occurred within 30 days of procedure. The cumulative survival was 92% and 90% for CABG and PCI, respectively (p = 0.003). Chronic renal insufficiency (adjusted hazard ratio [HR] 3.8, [95% confidence interval 3.1 to 4.6]), age (HR 1.5 per decade [1.3 to 1.6]), ejection fraction <40% (HR 1.3 [1.1 to 1.5] and PCI (HR 1.6 [1.3 to 1.9]) were the main predictors of increased mortality. Creatine kinase-MB isoform elevation only above 10 x ULN was independently predictive of mortality in the CABG (HR 1.3 [1.1 to 1.5]) and PCI (HR 1.1 [1.0 to 1.2]) groups, p < 0.001.


CONCLUSIONS
Creatine kinase MB isoform elevation after revascularization is very common, particularly in CABG patients. When extensive, it is independently correlated with increased mortality over a three-year period. Identification and aggressive management of patients with high levels of CK-MB after revascularization may improve their outcome.
Brener
Sorin J
SJ
Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. breners@ccf.org
Lytle
Bruce W
BW
Schneider
Jakob P
JP
Ellis
Stephen G
SG
Topol
Eric J
EJ
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000401:mortality; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000401:mortality; D003327:Coronary Disease / Q000097:blood / Q000401:mortality / Q000628:therapy; D003402:Creatine Kinase / Q000097:blood*; D052279:Creatine Kinase, MB Form; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007527:Isoenzymes / Q000097:blood*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009204:Myocardial Revascularization / Q000401:mortality; D009820:Ohio; D013223:Statistics as Topic; D013318:Stroke Volume / Q000502:physiology; D015996:Survival Rate; D013995:Time; D016896:Treatment Outcome
D015415:Biomarkers; D007527:Isoenzymes; D003402:Creatine Kinase; D052279:Creatine Kinase, MB Form