Creatine kinase-MB elevation after percutaneous coronary intervention predicts adverse outcomes in patients with acute coronary syndromes.
OBJECTIVE
To study the relationship between outcomes and peak creatine kinase (CK)-MB levels after percutaneous coronary intervention (PCI) in patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS).


RESULTS
Peak CK-MB ratios (peak CK-MB level/upper limit of normal [ULN]) after PCI were analysed in 6164 patients with NSTE ACS from four randomized trials who underwent in-hospital PCI. We excluded 696 patients with elevated CK or CK-MB levels <24h before PCI; the primary analysis included 2384 of the remaining 5468 patients (43.6%) with CK-MB levels measured <==24h after PCI. The incidence of in-hospital heart failure (0.1%, 0.8%, 3.4%, 4.1%, and 6.1%; P<0.001), arrhythmias (0.8%, 1.9%, 6.9%, 4.1%, and 7.9%; P<0.001), cardiogenic shock (0.1%, 1.3%, 2.0%, 2.3%, and 2.6%; P=0.004), and mortality through 6 months (2.1%, 2.4%, 4.9%, 4.1%, and 5.7%, P=0.005) was increased with peak CK-MB ratios of 0-1, 1-3, 3-5, 5-10, and >10xULN, respectively. The continuous peak CK-MB ratio after PCI significantly predicted adjusted 6-month mortality (risk ratio, 1.06 per unit increase above ULN; 95% confidence interval, 1.01-1.11; P=0.017).


CONCLUSIONS
Greater CK-MB elevation after PCI is independently associated with adverse outcomes in NSTE ACS. These results underscore the adverse implications of elevated CK-MB levels after PCI in this high-risk population.
Roe
M T
MT
Duke Clinical Research Institute, Durham, North Carolina, USA. roe00001@mc.duke.edu
Mahaffey
K W
KW
Kilaru
R
R
Alexander
J H
JH
Akkerhuis
K M
KM
Simoons
M L
ML
Harrington
R A
RA
Tardiff
B E
BE
Granger
C B
CB
Ohman
E M
EM
Moliterno
D J
DJ
Lincoff
A M
AM
Armstrong
P W
PW
Van de Werf
F
F
Califf
R M
RM
Topol
E J
EJ
D000208:Acute Disease; D000368:Aged; D015415:Biomarkers / Q000097:blood; D003327:Coronary Disease / Q000201:enzymology* / Q000401:mortality / Q000628:therapy; D003402:Creatine Kinase / Q000378:metabolism*; D052279:Creatine Kinase, MB Form; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007527:Isoenzymes / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018579:Patient Selection; D016896:Treatment Outcome
D015415:Biomarkers; D007527:Isoenzymes; D003402:Creatine Kinase; D052279:Creatine Kinase, MB Form