Relation of Post-Coronary Artery Bypass Graft Creatine Kinase-MB Elevations and New Q Waves With Long-Term Cardiovascular Death in Patients With Diabetes Mellitus and Multivessel Coronary Artery Disease.
Associations of early creatine phosphokinase-MB (CK-MB) elevation and new Q waves and their association with cardiovascular death (CVD) after coronary artery bypass grafting (CABG) have been reported, but this association has not been studied in a large population of patients with diabetes mellitus. In this study, we examine the association of periprocedural CK-MB elevations and new Q waves with CVD in the Future Revascularization Evaluation in Patients with Diabetes Mellitus: Optimal Management of Multivessel Disease trial. Cox proportional hazards regression was used to assess the relation of CK-MB elevations and new Q waves in the first 24 hours after procedure and their relation to CVD; logistic regression was used to assess odds ratios of these variables. Hazard ratios, 95% confidence intervals, and p values associated with Wald chi-square test are reported. CK-MB elevation in first 24 hours after procedure was independently associated with CVD. CVD hazard increased by 6% (p <0.001) with each multiple of CK-MB above the upper reference limit (URL); odds of new post-CABG Q waves increased by a factor of 1.08 (p <0.001); at 7× CK-MB URL, HR was >2. CK-MB URL multiples of 7, 12, and 15 were associated with new Q-wave odds ratios of 9, 16, and 27 times, respectively (p ≤0.001, C-statistic >0.70). New Q waves were independently associated with survival in the multivariate model only when CK-MB was excluded (p = 0.01). In conclusion, independent associations included (1) CVD and early post-CABG CK-MB elevation; (2) new Q waves with early post-CABG CK-MB elevation; (3) CVD with new Q waves only when CK-MB elevation is excluded from analysis.
Peter Munk Cardiac Centre and the Heart and Stroke Richard Lewar Centre, University of Toronto, Toronto, Canada. Electronic address: michael.domanski@uhn.ca.
Michael
M
Domanski
Peter Munk Cardiac Centre and the Heart and Stroke Richard Lewar Centre, University of Toronto, Toronto, Canada.
Michael E
ME
Farkouh
The New England Research Institute, Watertown, Massachusetts.
Victor
V
Zak
Liverpool Hospital, University of New South Wales, Sydney, Australia.
John
J
French
Duke Clinical Research Institute, Duke Medicine, Durham, North Carolina.
John H
JH
Alexander
Medical University of Silesia, Katowice, Poland.
Andrzej
A
Bochenek
CHU Caen, Caen, France.
Martial
M
Hamon
Duke Clinical Research Institute, Duke Medicine, Durham, North Carolina.
Kenneth
K
Mahaffey
CHU Caen, Caen, France.
John
J
Puskas
Emory University Hospital Midtown, Atlanta, Georgia.
Peter
P
Smith
The New England Research Institute, Watertown, Massachusetts.
Peter
P
Shrader
Icahn School of Medicine at Mount Sinai, New York, NY; Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain.
Valentin
V
Fuster
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002423:Cause of Death / Q000639:trends; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000201:enzymology* / Q000401:mortality / Q000601:surgery; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000601:surgery; D052279:Creatine Kinase, MB Form / Q000097:blood*; D003920:Diabetes Mellitus / Q000097:blood* / Q000401:mortality; D004562:Electrocardiography; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009517:New South Wales / Q000453:epidemiology; D009864:Ontario / Q000453:epidemiology; D011184:Postoperative Period; D011379:Prognosis; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology
D015415:Biomarkers; D052279:Creatine Kinase, MB Form