Elevated CK-MB values after routine angioplasty predicts worse long-term prognosis in low-risk patients.
OBJECTIVE
The long-term prognostic value (>5 years) of elevated cardiac biomarkers after elective coronary angioplasty is yet not clear. Most previous studies have included high risk, unstable patients. The aim of this study was to determine the prognostic value of CK-MB mass > or = three times the reference after elective angioplasty in low-risk patients with stable angina.


METHODS
A total of 278 consecutive patients were included in the final analysis. Patients with elevated CK-MB values at baseline, and those suffering an acute coronary syndrome <1 month before the time of inclusion, were excluded. Blood samples were drawn just before and 1-3 hours, 4-8 hours after the procedure and the next morning. Nineteen patients (6.8%) had peak CK-MB mass values > or =15 microg/L (three times the reference), and 259 patients had values <15 microg/L (defined as controls). No patient developed new Q-waves on ECG. The median follow-up time was 80.5 months.


RESULTS
None of the patients died during the procedure or within the first 30 days after angioplasty, confirming a low risk cohort. All cause mortality, readmission for acute coronary syndromes and target lesion revascularisation (TLR) were more frequent in patients with high CK-MB, 42.1% vs. 22.8%, p=0.034 (log rank). In a multivariate logistic regression analysis, high CK-MB and former angioplasty were the only variables independently related to a reduced event-free survival.


CONCLUSIONS
CK-MB mass values > or = three times the reference after elective angioplasty predicts reduced long-term event-free survival.
Vikenes
Kjell
K
Department of Heart Disease, Haukeland University Hospital, Bergen, Norway. vike@haukeland.no
Melberg
Tor
T
Farstad
Mikael
M
Nordrehaug
Jan Erik
JE
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000201:enzymology / Q000209:etiology / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000295:instrumentation / Q000401:mortality; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D023921:Coronary Stenosis / Q000150:complications / Q000201:enzymology / Q000401:mortality / Q000628:therapy*; D052279:Creatine Kinase, MB Form / Q000097:blood*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D015854:Up-Regulation
D015415:Biomarkers; D052279:Creatine Kinase, MB Form