Impact of periprocedural myonecrosis on clinical events after implantation of drug-eluting stents.
BACKGROUND
High level of creatine kinase myocardial band isoenzyme (CK-MB) elevation has been associated with late mortality after coronary intervention. We sought to evaluate the impact of periprocedural myonecrosis on clinical events in patients undergoing drug-eluting stents (DES) implantation.


METHODS
A total of 1807 patients (2550 lesions) with successful DES implantation were followed for mean duration of 13 + or - 7 months. Patients with acute myocardial infarction and those with elevated CK-MB at baseline were excluded. Based on the CK-MB levels after stenting, patients were classified into three groups: group I: normal CK-MB (n=1429, 79.1%), group II: 1 to 5 times normal CK-MB (n=263, 14.6%), and group III: >5 times normal CK-MB (n=115, 6.4%). Major adverse cardiac events (MACE) were defined as cardiac death, myocardial infarction, and target lesion revascularization.


RESULTS
With increasing levels of periprocedural CK-MB, there was an increased incidence of MACE (5.0% in group I vs. 6.1% in group II vs. 10.4% in group III, p=0.010) and cardiac death (0.5% in group I vs. 1.1% in group II vs. 2.6% in group III, p=0.016). By multivariate analysis, periprocedural peak CK-MB level was independent predictor of MACE (hazard ratio 1.01, 95% confidence interval 1.00 to 1.03; p=0.044).


CONCLUSIONS
Periprocedural myonecrosis was significantly associated with subsequent adverse clinical events after DES implantation.
Department of Medicine, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Pungnap-dong, Songpa-gu, Seoul, 138-736, Republic of Korea.
Jae-Sik
JS
Jang
Myeong-Ki
MK
Hong
Duk-Woo
DW
Park
Seung-Whan
SW
Lee
Young-Hak
YH
Kim
Cheol Whan
CW
Lee
Jae-Joong
JJ
Kim
Seong-Wook
SW
Park
Seung-Jung
SJ
Park
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D052279:Creatine Kinase, MB Form / Q000378:metabolism; D054855:Drug-Eluting Stents / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000201:enzymology / Q000473:pathology*; D009336:Necrosis / Q000150:complications / Q000401:mortality / Q000473:pathology
D052279:Creatine Kinase, MB Form