title: Predictors of periprocedural creatine kinase-myocardial band elevation complicating elective percutaneous coronary intervention.
abstract: Limited data are available regarding the predictors of periprocedural creatine kinase-MB (CK-MB) isoenzyme increase after elective percutaneous coronary intervention (PCI) in the stenting era. We explored the predictors of periprocedural CK-MB increase in 882 consecutive patients with normal preprocedural CK-MB who underwent 919 angiographically successful elective PCIs with (n = 814) or without (n = 105) stenting. Patients were categorized into 3 groups based on their peak CK-MB levels after PCI: (1) normal CK-MB (n = 761), (2) minor CK-MB increase (CK-MB 1 to 3 times normal, n = 112), and (3) major CK-MB increase (CK-MB >3 times normal, n = 46). By logistic regression analysis, independent predictors for minor CK-MB increase included thrombus (odds ratio [OR] 5.09, p = 0.001), platelet IIb/IIIa antagonist use (OR 0.53, p <0.01), number of lesions treated (per additional lesion, OR 1.54, p <0.01), maximum balloon size (per millimeter increase, OR 1.57, p <0.05), American College of Cardiology/American Heart Association type C lesion (OR 1.68, p <0.05), sustained chest pain during procedure (OR 1.94, p <0.05), dissection (OR 2.05, p <0.05), and transient side branch occlusion (OR 4.54, p <0.05). Independent predictors for major CK-MB increase were chest pain at end of procedure (OR 9.66, p <0.001), type C lesion (OR 2.42, p <0.05), Canadian Cardiovascular Society angina class III to IV (OR 3.32, p <0.05), thrombus (OR 5.09, p = 0.001), and abrupt closure (OR 5.30, p <0.05). In conclusion, baseline clinical and angiographic characteristics and procedural complications were associated with minor and major CK-MB increases. Patients with chest pain at the end of the procedure were at the highest risk for major CK-MB increase.
authors.affiliation: Department of Internal Medicine, Geisinger Medical Center, Danville, Pennsylvania, USA.
authors.forename: Qiangjun
authors.initials: Q
authors.lastname: Cai
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Skelding
authors.forename: Arthur T
authors.initials: AT
authors.lastname: Armstrong
authors.forename: Dipan
authors.initials: D
authors.lastname: Desai
authors.forename: G Craig
authors.initials: GC
authors.lastname: Wood
authors.forename: James C
authors.initials: JC
authors.lastname: Blankenship
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000201:enzymology* / Q000628:therapy*; D052279:Creatine Kinase, MB Form / Q000097:blood*; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents
chemical_list: D052279:Creatine Kinase, MB Form