Myonecrosis following isolated coronary artery bypass grafting is common and associated with an increased risk of long-term mortality.
OBJECTIVE
We sought to evaluate the risk of long-term mortality with respect to post-operative elevation of the isoenzyme CK-MB following first-time isolated coronary artery bypass grafting (CABG) surgery.


METHODS
Patients undergoing first-time isolated CABG between September 1992 and December 2001, at the Mid America Heart Institute, were included in this registry analysis. A sole CK-MB measurement was obtained at an average of 15.2h following CABG. The main endpoint was long-term mortality.


RESULTS
There were 3667 patients included in this registry. The mean follow up was 5.1 years. The event-free survival rate was 80%, 78% and 73%, for the normal, 1-3 and >3 times by ULN groups respectively; log-rank p=0.0058. The event-free survival for the four CK-MB groups was 80%, 78%, 75% and 72% for the normal, 1-3 times, >3-5, and >5 times ULN groups respectively, log-rank p=0.0078. The CK-MB elevation following CABG remained a significant predictor following multivariate adjustment. With a point estimate of 1.04, 95% confidence limits 1.009-1.062, p=0.007.


CONCLUSIONS
Elevation of the isoenzyme CK-MB is an important predictor of longterm mortality following coronary bypass grafting. These data support routine use of creatinine kinase measurement following bypass surgery to further delineate long-term risk.
Marso
Steven P
SP
Mid America Heart Institute, Kansas City, Missouri 64111, USA. smarso@saint-lukes.org
Bliven
Brent D
BD
House
John A
JA
Muehlebach
Gregory F
GF
Borkon
A Michael
AM
D015415:Biomarkers / Q000097:blood; D001026:Coronary Artery Bypass / Q000401:mortality*; D003327:Coronary Disease / Q000097:blood / Q000401:mortality / Q000601:surgery*; D003402:Creatine Kinase / Q000097:blood*; D052279:Creatine Kinase, MB Form; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007527:Isoenzymes / Q000097:blood*; D008297:Male; D008875:Middle Aged; D016019:Survival Analysis
D015415:Biomarkers; D007527:Isoenzymes; D003402:Creatine Kinase; D052279:Creatine Kinase, MB Form