title: Prognostic implications of creatine kinase-MB measurements in ST-segment elevation myocardial infarction patients treated with primary percutaneous coronary intervention.
abstract: BACKGROUND
  Peak creatine kinase (CK)-MB concentration is related to reperfusion success and clinical outcomes after fibrinolytic therapy for acute myocardial infarction. However, prognostic implications of CK-MB measurements after primary percutaneous coronary intervention (PCI), which provides more predictable and consistent reperfusion, are unknown.
  
  
  METHODS
  We pooled 2,042 primary PCI-treated ST-segment elevation myocardial infarction (STEMI) patients from 3 trials with serial core laboratory-determined CK-MB measurements; 1,799 patients (88.1%) who survived to 36 hours and had ≥4 CK-MB measurements were studied. Cox regression modeling was performed to quantify the association between peak CK-MB concentration (and area under the time-concentration curve [AUC]) and mortality at 6 months, and death or congestive heart failure at 90 days.
  
  
  RESULTS
  The median (25th-75th percentiles) peak CK-MB concentration and AUC measurement through 36 hours were 239 (109-429) ng/mL and 4,263 (2,081-7,124) ng/(mL h), respectively. By multivariable analysis, peak CK-MB concentration and AUC measurement were independently associated with 6-month mortality (adjusted hazard ratio [HR] 1.15, 95% CI 1.05-1.25, per 100-ng/mL increase, P = .002; and adjusted HR 1.09, 95% CI 1.03-1.14, per 1,000-ng/[mL h] increase, P < .001, respectively) and 90-day death or congestive heart failure (adjusted HR 1.26, 95% CI 1.18-1.34, P < .001; and adjusted HR 1.15, 95% CI 1.11-1.19, P < .001, respectively).
  
  
  CONCLUSIONS
  Peak CK-MB concentration and AUC measurement are independent predictors of 3- to 6-month cardiovascular outcomes in primary PCI-treated STEMI patients. Our findings guide application of these measurements as efficacy end points in early-phase studies evaluating new therapies for STEMI.
authors.affiliation: St. Michael's Hospital, University of Toronto, Ontario, Canada.
authors.forename: Akshay
authors.initials: A
authors.lastname: Bagai
authors.affiliation: Duke Clinical Research Institute, Durham, NC.
authors.forename: Phillip J
authors.initials: PJ
authors.lastname: Schulte
authors.affiliation: Duke Clinical Research Institute, Durham, NC.
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Granger
authors.affiliation: Duke Clinical Research Institute, Durham, NC.
authors.forename: Kenneth W
authors.initials: KW
authors.lastname: Mahaffey
authors.affiliation: Department of Pathology, University of Maryland, Baltimore, MD.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Christenson
authors.affiliation: Genentech, Inc., San Francisco, California.
authors.forename: Gregory
authors.initials: G
authors.lastname: Bell
authors.affiliation: Duke Clinical Research Institute, Durham, NC.
authors.forename: Renato D
authors.initials: RD
authors.lastname: Lopes
authors.affiliation: Duke Clinical Research Institute, Durham, NC.
authors.forename: Cynthia L
authors.initials: CL
authors.lastname: Green
authors.affiliation: Cleveland Clinic Foundation/Cleveland Clinical Coordinating Center for Clinical Research (C5Research), Cleveland, OH.
authors.forename: A Michael
authors.initials: AM
authors.lastname: Lincoff
authors.affiliation: Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Paul W
authors.initials: PW
authors.lastname: Armstrong
authors.affiliation: Duke Clinical Research Institute, Durham, NC. Electronic address: matthew.roe@duke.edu.
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Roe
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D002170:Canada / Q000453:epidemiology; D052279:Creatine Kinase, MB Form / Q000097:blood*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000401:mortality / Q000601:surgery*; D062645:Percutaneous Coronary Intervention; D011237:Predictive Value of Tests; D011379:Prognosis; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D052279:Creatine Kinase, MB Form