title: Creatine kinase-MB elevation after coronary artery bypass grafting surgery in patients with non-ST-segment elevation acute coronary syndromes predict worse outcomes: results from four large clinical trials.
abstract: OBJECTIVE
  To assess the significance of creatine kinase (CK)-MB elevations in outcomes of patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS) who have undergone coronary artery bypass grafting (CABG) surgery.
  
  
  RESULTS
  This analysis includes data from 26 465 patients with NSTE ACS enrolled in four major trials. In total, 4626 (17.5%) of patients had CABG within 30 days. Patients were excluded if CK-MB was elevated within 24 h before surgery and there was no CK-MB measured after surgery. Overall, 4401 patients were included in these analyses. The incidence of mortality increased with peak CK-MB ratios of 0-1, >1-3, >3-5, >5-10, and>10x the upper limit of normal measured at the local lab (P<0.001 across categories): 1.1, 2.8, 2.4, 3.1, and 10.8% in hospital; 1.1, 3.0, 2.9, 3.5, and 10.2% at 30 days; and 1.6, 4.4, 4.7, 6.0, and 10.9% at 180 days. Multivariable predictors of 6-month mortality included age, heart rate and randomization, peak CK-MB ratio, time to CABG, prior angina, signs of congestive heart failure and randomization, three- and two-vessel coronary disease, enrolment infarction, ST-segment depression at enrolment, female sex, experimental treatment, and systolic blood pressure.
  
  
  CONCLUSIONS
  CK-MB elevations after CABG are independently associated with increased risk of mortality in patients with NSTE ACS.
authors.affiliation: Duke Clinical Research Institute, PO Box 17969, Durham, NC 27715, USA, and Catholic University Hospital, Leuven, Belgium. mahaf002@mc.duke.edu
authors.forename: Kenneth W
authors.initials: KW
authors.lastname: Mahaffey
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Roe
authors.forename: Rakhi
authors.initials: R
authors.lastname: Kilaru
authors.forename: John H
authors.initials: JH
authors.lastname: Alexander
authors.forename: Frans
authors.initials: F
authors.lastname: Van de Werf
authors.forename: Robert M
authors.initials: RM
authors.lastname: Califf
authors.forename: Maarten L
authors.initials: ML
authors.lastname: Simoons
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Topol
authors.forename: Robert A
authors.initials: RA
authors.lastname: Harrington
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D001026:Coronary Artery Bypass / Q000401:mortality*; D003327:Coronary Disease / Q000201:enzymology* / Q000401:mortality / Q000601:surgery; D052279:Creatine Kinase, MB Form / Q000378:metabolism*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000401:mortality; D016032:Randomized Controlled Trials as Topic; D012044:Regression Analysis; D012770:Shock, Cardiogenic / Q000209:etiology / Q000401:mortality; D020521:Stroke / Q000209:etiology / Q000401:mortality; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D052279:Creatine Kinase, MB Form