title: The contemporary value of peak creatine kinase-MB after ST-segment elevation myocardial infarction above other clinical and angiographic characteristics in predicting infarct size, left ventricular ejection fraction, and mortality.
abstract: BACKGROUND
  Complex multimarker approaches to predict outcome after ST-elevation myocardial infarction (STEMI) have only considered a single baseline sample, while neglecting easily obtainable peak creatine kinase and creatine kinase-MB (CK-MB) values during hospitalization.
  
  
  METHODS
  We studied 476 patients undergoing primary percutaneous coronary intervention for STEMI and cardiac magnetic resonance imaging (CMRI) at 4-6 months after STEMI. We determined the association with cardiac biomarkers (peak CK-MB, peak troponin T, N-terminal pro-brain natriuretic peptide), clinical and angiographic characteristics with infarct size, and LVEF, followed by association with mortality in 1120 STEMI patients.
  
  
  RESULTS
  Peak CK-MB was the strongest predictor for infarct size (P<0.001, R2=0.60) and LVEF (P<0.001, R2=0.40). The additional value of clinical and angiographic characteristics was limited. The optimal peak CK-MB cutpoints, for differentiation among small (<10% of the left ventricle), moderate (≥10%-<30%), and large infarct size (≥30%), were 210 U/L and 380 U/L, respectively. These cutpoints were associated with 90-day mortality; the hazard ratio for moderate infarct was 2.99 (95% confidence interval [CI]: 1.51-5.93, P=0.002) and for large infarct 6.53 (95% CI: 3.63-11.76, P<0.001).
  
  
  CONCLUSIONS
  Classical peak CK-MB measured during hospitalization for STEMI was superior to other clinical and angiographic characteristics in predicting CMRI-defined infarct size and LVEF, and should be included and validated in future multimarker studies. Peak CK-MB cutpoints differentiated among infarct size categories and were associated with increased 90-day mortality risk.
authors.affiliation: Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
authors.forename: Minke H T
authors.identifier: http://orcid.org/0000-0002-6965-3259
authors.initials: MHT
authors.lastname: Hartman
authors.affiliation: Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
authors.forename: Ruben N
authors.initials: RN
authors.lastname: Eppinga
authors.affiliation: Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
authors.forename: Pieter J J
authors.initials: PJJ
authors.lastname: Vlaar
authors.affiliation: Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
authors.forename: Chris P H
authors.initials: CPH
authors.lastname: Lexis
authors.affiliation: Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
authors.forename: Erik
authors.initials: E
authors.lastname: Lipsic
authors.affiliation: Department of Cardiology, Academic Medical Center Amsterdam, University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: Joost D E
authors.initials: JDE
authors.lastname: Haeck
authors.affiliation: Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: van Veldhuisen
authors.affiliation: Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
authors.forename: Iwan C C
authors.initials: ICC
authors.lastname: van der Horst
authors.affiliation: Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
authors.forename: Pim
authors.initials: P
authors.lastname: van der Harst
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D002423:Cause of Death; D017023:Coronary Angiography; D052279:Creatine Kinase, MB Form / Q000097:blood*; D005260:Female; D006760:Hospitalization; D006801:Humans; D016014:Linear Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009206:Myocardium / Q000473:pathology*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality; D011237:Predictive Value of Tests; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D015854:Up-Regulation; D016277:Ventricular Function, Left
chemical_list: D015415:Biomarkers; D052279:Creatine Kinase, MB Form
keywords: Imaging; Ischemic heart disease; LVEF; creatine kinase MB; magnetic resonance imaging; mortality; myocardial infarction