title: Long-term prognostic value of CK-MB and the troponins after angioplasty in patients with stable angina.
abstract: 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 and with conflicting results. The aim of this study was to determine the prognostic value of CK-MB mass vs. the cardiac troponins (values ≥ 3 times the reference) after elective angioplasty in low-risk patients with stable angina.
  
  
  METHODS
  A total of 202 consecutive patients were included in the final analysis. Patients with elevated 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, 1-3 hours and 4-8 hours after the procedure and the next morning. Using a cutoff value of three times the reference, patients with high and low values (= controls) of CK-MB mass, cardiac troponin T (TnT) and troponin I (TnI) were compared. No patient developed new Q-waves on ECG. The median follow-up time was 82 months equalising 1600 patient years.
  
  
  RESULTS
  None of the patients died during the procedure or within the first 30 days after angioplasty, confirming a low risk cohort. There was an increasingly number of patients with levels ≥ 3 times the reference post procedure in TnT (10.4%) and TnI (16.8%) vs. CK-MB (6.9%). All cause mortality, readmission for acute coronary syndromes and target lesion revascularisation were more frequent in patients with high CK-MB, 42.9% vs. 22.3 %, p = 0.05 (log-rank test). Corresponding values for TnT were 33.3% vs. 22.7%, p = 0.22. In the TnI patients, there were more adverse events in controls vs. the high group, 25.0% vs. 17.6%, p = 0.34.
  
  
  CONCLUSIONS
  CK-MB mass values ≥ 3 times, contrary to the cardiac troponins, predicts worse long-term event-free survival after elective angioplasty in low-risk patients.
authors.affiliation: Department of Heart Disease, Haukeland University Hospital, Bergen, Norway. vike@haukeland.no
authors.forename: Kjell
authors.initials: K
authors.lastname: Vikenes
authors.forename: Tor
authors.initials: T
authors.lastname: Melberg
authors.forename: Mikael
authors.initials: M
authors.lastname: Farstad
authors.forename: Jan Erik
authors.initials: JE
authors.lastname: Nordrehaug
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000097:blood / Q000628:therapy*; D015906:Angioplasty, Balloon, Coronary; D015415:Biomarkers / Q000097:blood; D052279:Creatine Kinase, MB Form / Q000097:blood*; D017558:Elective Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome; D019210:Troponin I / Q000097:blood*; D020107:Troponin T / Q000097:blood*
chemical_list: D015415:Biomarkers; D019210:Troponin I; D020107:Troponin T; D052279:Creatine Kinase, MB Form