title: Usefulness of periprocedural creatinine phosphokinase-MB release to predict adverse outcomes after intracoronary radiation therapy for in-stent restenosis.
abstract: We aimed to analyze periprocedural creatinine phosphokinase (CPK)-MB elevation in patients treated with intracoronary radiation therapy (IRT) for in-stent restenosis (ISR) to risk stratify these patients. The clinical significance of periprocedural CPK-MB elevation after IRT for ISR is unknown. An elevated CPK-MB has been associated with increased mortality after conventional angioplasty. We evaluated 1,326 patients who were enrolled in radiation trials for ISR at the Washington Hospital Center using gamma- and beta-emitters. Patients were analyzed according to degree of CPK-MB increase within 24 hours of the index IRT procedure (normal CPK-MB, CPK-MB 1 to 3 times the upper limit of normal, or CPK-MB >3 times the upper limit of normal). Patients with CPK-MB >3 times the upper limit of normal were older (64 +/- 12 years, p = 0.04), more likely to be smokers (64%, p = 0.04), hypertensive (85%, p <0.01), and diabetic (49%, p = 0.04). The cohort with the highest CPK-MB release (CPK-MB >3 times the upper limit of normal) had significantly higher rates of adverse clinical events at 12 months (major adverse cardiac events 40%, p <0.01), including death (9.3%, p <0.01) and late thrombosis (6.3%, p <0.01). Periprocedural CPK-MB elevation is of prognostic importance in patients treated with IRT for ISR, and its analysis appears to be mandatory to risk stratify these patients. The impact of glycoprotein IIb/IIIa antagonists in reducing periprocedural CPK-MB release awaits evaluation.
authors.affiliation: Royal Melbourne Hospital, Melbourne, Australia.
authors.forename: Andrew E
authors.initials: AE
authors.lastname: Ajani
authors.forename: Ron
authors.initials: R
authors.lastname: Waksman
authors.forename: Arvind K
authors.initials: AK
authors.lastname: Sharma
authors.forename: Robert
authors.initials: R
authors.lastname: Lew
authors.forename: Ellen
authors.initials: E
authors.lastname: Pinnow
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Canos
authors.forename: Edouard
authors.initials: E
authors.lastname: Cheneau
authors.forename: Marco
authors.initials: M
authors.lastname: Castagna
authors.forename: Dong-Hun
authors.initials: DH
authors.lastname: Cha
authors.forename: Laurent
authors.initials: L
authors.lastname: Leborgne
authors.forename: Lowell F
authors.initials: LF
authors.lastname: Satler
authors.forename: Augusto D
authors.initials: AD
authors.lastname: Pichard
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Kent
authors.forename: Joseph
authors.initials: J
authors.lastname: Lindsay
mesh_terms: D000368:Aged; D023921:Coronary Stenosis / Q000628:therapy / Q000652:urine*; D003402:Creatine Kinase / Q000378:metabolism*; D052279:Creatine Kinase, MB Form; D003404:Creatinine / Q000652:urine*; D005260:Female; D006083:Graft Occlusion, Vascular / Q000532:radiotherapy* / Q000652:urine*; D006801:Humans; D007527:Isoenzymes / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011237:Predictive Value of Tests; D016896:Treatment Outcome
chemical_list: D007527:Isoenzymes; D003404:Creatinine; D003402:Creatine Kinase; D052279:Creatine Kinase, MB Form