Long-term prognostic value of creatine kinase-myocardial band mass after cardiac surgery in low-risk patients with stable angina.
OBJECTIVE
The long-term prognostic value (>5 years) of elevated cardiac biomarkers after elective cardiac surgery is not clear. Most previous studies have included high-risk, unstable patients. The aim of this study was to determine the prognostic value of creatine kinase-myocardial band (CK-MB) mass after elective cardiac surgery in low-risk patients with stable angina.


METHODS
A total of 230 consecutive patients undergoing cardiac surgery were included in the final analysis. Blood samples were drawn just before and 1-3 and 4-8 h after the procedure, and every morning thereafter for 3 days. Using a cutoff value of 5 times the reference, 100 patients (43.6%) had peak CK-MB mass values > or =25 microg/l, and 130 patients had values <25 microg/l (defined as controls). No patient developed new Q waves on ECG. The median follow-up time was 95 months.


RESULTS
All-cause mortality and readmission for acute coronary syndromes were more frequent in the high-CK-MB group (30.0 vs. 17.9%, p = 0.022), as was target vessel revascularization (20.6 vs. 5.4%). Comparing the quartiles of peak CK-MB values in a Kaplan-Meier survival plot, event-free survival for the upper quartile (n = 60) was 68.3%, and for the lower quartile (n = 55), it was 83.6% (p = 0.046). In a multivariate logistic regression analysis, high CK-MB and ejection fraction were the only variables independently related to reduced event-free survival.


CONCLUSIONS
CK-MB values > or =5 times the reference after elective cardiac surgery are associated with reduced long-term event-free survival.
Vikenes
Kjell
K
Department of Heart Disease, Haukeland University Hospital, Bergen NO-5021, Norway. kjell.vikenes@helse-bergen.no
Andersen
Knut S
KS
Melberg
Tor
T
Farstad
Mikael
M
Nordrehaug
Jan Erik
JE
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000097:blood* / Q000453:epidemiology*; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data*; D052279:Creatine Kinase, MB Form / Q000097:blood*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000097:blood* / Q000453:epidemiology*; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors
D052279:Creatine Kinase, MB Form