title: A study comparing the incidence and predictors of creatine kinase MB and troponin T release after coronary angioplasty. Does Clopidogrel preloading reduce myocardial necrosis following elective percutaneous coronary intervention?
abstract: BACKGROUND
  To investigate the incidence and associated factors for enzyme release following percutaneous coronary intervention comparing assessment with creatine kinase MB (CK-MB) and troponin T (TnT).
  
  
  METHODS
  TnT and CK-MB were measured post procedure in a consecutive series of 933 patients undergoing elective percutaneous coronary intervention between 1/4/2003 and 1/5/2004 at a single regional cardiac centre.
  
  
  RESULTS
  CK-MB level significantly correlated to TnT levels (R=0.747, p<0.001) and a CK-MB level of above 3 times the upper limit of the local reference range (>3 x ULN) was predicted with 95% sensitivity (48% specificity) at a TnT level of 0.11. Multivariate predictors of >3 x ULN CK-MB release for uncomplicated percutaneous coronary intervention (n=898) were multi-vessel angioplasty (OR=2.51, 95% CI=1.57 to 4.01; p<0.001), saphenous venous graft angioplasty (OR=5.5, 95% CI=1.94 to 13.00; p=0.005) and lack of Clopidogrel preloading (OR=2.02, 95% CI=1.30 to 4.38; p=0.027).
  
  
  CONCLUSIONS
  TnT was found to be a sensitive although not a highly specific marker of CK-MB release. In this study a TnT level above a threshold of 0.11 would identify 95% of the prognostically important 3-fold CK-MB releases. Replacing the >3 x ULN CK-MB threshold with a TnT level of 0.1 ng/l following percutaneous coronary intervention would increase the apparent rate of myocardial infarction from 11% to 20%. Lack of Clopidogrel preloading was independently associated with a >3 x ULN CK-MB release following uncomplicated elective percutaneous coronary intervention.
authors.affiliation: The Cardiothoracic Center, Liverpool NHS Trust, Thomas Drive, Liverpool, L14 3PE, UK.
authors.forename: Roger K G
authors.initials: RK
authors.lastname: Moore
authors.forename: Robert
authors.initials: R
authors.lastname: Lowe
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Grayson
authors.forename: John L
authors.initials: JL
authors.lastname: Morris
authors.forename: Raphael A
authors.initials: RA
authors.lastname: Perry
authors.forename: Rodney H
authors.initials: RH
authors.lastname: Stables
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data*; D015415:Biomarkers / Q000378:metabolism; D000077144:Clopidogrel; D015331:Cohort Studies; D003327:Coronary Disease / Q000453:epidemiology / Q000378:metabolism* / Q000628:therapy*; D052279:Creatine Kinase, MB Form / Q000378:metabolism*; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009206:Myocardium / Q000473:pathology; D009336:Necrosis / Q000188:drug therapy; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D011300:Preoperative Care; D012680:Sensitivity and Specificity; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D020107:Troponin T / Q000378:metabolism*; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D010975:Platelet Aggregation Inhibitors; D020107:Troponin T; D000077144:Clopidogrel; D052279:Creatine Kinase, MB Form; D013988:Ticlopidine