Visible angiographic complications predict short and long-term outcomes in patients with post-procedural creatine-phosphokinase elevation.
OBJECTIVE
To assess whether visible angiographic complication is related to outcome in patients with elevated creatine phosphokinase (CK-MB) following percutaneous coronary intervention (PCI).


BACKGROUND
Elevated biomarkers following PCI are associated with increased incidence of adverse events but the absolute risk of such events is low. A more specific marker of risk is needed.


METHODS
Consecutive patients with elevated post-PCI CK-MB were divided into two groups according to presence (n = 115, 43%) or absence (n = 150, 57%) of an angiographic complication. A control group (n = 250) was randomly chosen from 2,403 patients undergoing PCI during the same period without CK-MB elevation. Major adverse cardiac events (MACE) were assessed at 30 days and 1 year.


RESULTS
Patients with an identifiable angiographic complication and elevated postprocedural CK-MB had significantly worse outcomes at 30 days and 1 year compared with biomarker positive patients without an identifiable complication and control patients (30 day MACE rate: 8% vs 0% vs 0.4%, respectively, p < 0.001; 1 year MACE rate: 26% vs 11% vs 11%, respectively, p = 0.002, all p-values for angiographic complication vs no angiographic complication and for angiographic complication vs control). Biomarker positive patients without identifiable angiographic complication had an excellent short and long term outcome, which was no different from biomarker negative patients (1 year MACE rate: 11% vs 11%, p = 0.53).


CONCLUSIONS
Post-PCI patients without visible angiographic complications have an excellent short and long term outcome. These findings call into question the need for routine CK-MB monitoring after PCI in the absence of clinical symptoms or angiographic complication.
Fefer
Paul
P
Leviev Hear Center, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv, Israel. paulfefer@gmail.com
Daoulah
Amin
A
Strauss
Bradley H
BH
Chisholm
Robert
R
Sparkes
John D
JD
Segev
Amit
A
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000401:mortality; D015415:Biomarkers / Q000097:blood; D002932:Cineangiography; D017023:Coronary Angiography; D003402:Creatine Kinase / Q000097:blood*; D005260:Female; D006331:Heart Diseases / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D006801:Humans; D016018:Least-Squares Analysis; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D009864:Ontario; D011237:Predictive Value of Tests; D012044:Regression Analysis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D015854:Up-Regulation
D015415:Biomarkers; D003402:Creatine Kinase