Impact of periprocedural creatine kinase-MB isoenzyme release on long-term mortality in contemporary percutaneous coronary intervention.
OBJECTIVE
To evaluate the incidence of periprocedural creatine kinase-MB (CK-MB) release and its impact on longterm mortality in contemporary percutaneous coronary intervention (PCI) at a tertiary referral center.


METHODS
Retrospective analysis of 4,958 patients undergoing PCI with deployment of at least 1 stent at our center between January 1, 2003 and December 31, 2005. Patients admitted with acute ST-elevation myocardial infarction or cardiogenic shock (n = 617), and patients with no available CK-MB levels (n = 477) were excluded, leaving 3,864 patients for analysis. The outcome measure was all-cause mortality obtained from the National Strategic Tracing Service with patients followed up to June 30, 2006 (mean follow up 22 months). The association between CK-MB level and mortality was examined using Cox proportional hazards analysis.


RESULTS
CK-MB elevation above the upper limit of normal (ULN) was detected in 29.4% patients. A total of 127 deaths were observed during follow up. By multivariate analysis, periprocedural CK-MB was independently associated with an increased risk of death (adjusted hazard ratio for every 10 units: 1.09; 95% CI: 1.05-1.12; p < 0.001). The relationship between the level of CK-MB and mortality was further examined by applying strata of CK-MB levels to the multivariate analysis (adjusted hazard ratio: 1.30, 1.76 and 2.26 for CK-MB levels of 1-3, 3-5 and > 5 the ULN, respectively).


CONCLUSIONS
In the current era of PCI, periprocedural myonecrosis, evidenced by CK-MB elevation, is common and is associated with less favorable long-term mortality.
Andron
Mohammed
M
Cardiology Department, Cardiothoracic Centre, Thomas Drive, Liverpool, L14 3PE, United Kingdom. mohammedandron@blueyonder.co.uk
Stables
Rodney H
RH
Egred
Mohaned
M
Alahmar
Albert E
AE
Shaw
Matthew A
MA
Roberts
Elved
E
Albouaini
Khaled
K
Grayson
Anthony D
AD
Perry
Raphael A
RA
Palmer
Nicholas D
ND
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D015415:Biomarkers / Q000097:blood; D003327:Coronary Disease / Q000201:enzymology* / Q000401:mortality / Q000628:therapy; D052279:Creatine Kinase, MB Form / Q000097:blood*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000201:enzymology* / Q000401:mortality / Q000628:therapy; D009206:Myocardium / Q000201:enzymology*; D017063:Outcome Assessment, Health Care; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015607:Stents
D015415:Biomarkers; D052279:Creatine Kinase, MB Form