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J Am Coll Cardiol, 1999; 33:88-96
© 1999 by the American College of Cardiology Foundation
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CLINICAL STUDIES

Clinical outcomes after detection of elevated cardiac enzymes in patients undergoing percutaneous intervention

Barbara E. Tardiff, MDa, Robert M. Califf, MD, FACCa, James E. Tcheng, MD, FACCa, A. Michael Lincoff, MD, FACC*, Kristina N. Sigmon, MAa, Robert A. Harrington, MD, FACCa, Kenneth W. Mahaffey, MDa, E. Magnus Ohman, MD, FACCa, Paul S. Teirstein, MD, FACC{dagger}, James C. Blankenship, MD, FACC{ddagger}, Michael M. Kitt, MD§, Eric J. Topol, MD, FACC* for the IMPACT-II Investigators

a Duke Clinical Research Institute, Durham, North Carolina, USA
* the Cleveland Clinic Foundation, Cleveland, Ohio, USA
{dagger} Scripps Clinic, La Jolla, California, USA
{ddagger} Geisinger Medical Center, Danville, Pennsylvania, USA
§ COR Therapeutics, South San Francisco, California, USA

Manuscript received May 21, 1998; revised manuscript received August 6, 1998, accepted September 4, 1998.

Address for correspondence: Dr. Barbara E. Tardiff, Duke Clinical Research Institute, P.O. Box 17969, Durham, North Carolina 27710
tardi002{at}mc.duke.edu

Objectives. We examined the relations of elevated creatine kinase (CK) and its myocardial band isoenzyme (CK-MB) to clinical outcomes after percutaneous coronary intervention (PCI) in patients enrolled in Integrilin (eptifibatide) to Minimize Platelet Aggregation and Coronary Thrombosis-II (trial) (IMPACT-II), a trial of the platelet glycoprotein IIb/IIIa inhibitor eptifibatide.

Background. Elevation of cardiac enzymes often occurs after PCI, but its clinical implications are uncertain.

Methods. Patients undergoing elective, scheduled PCI for any indication were analyzed. Parallel analyses investigated CK (n = 3,535) and CK-MB (n = 2,341) levels after PCI (within 4 to 20 h). Clinical outcomes at 30 days and 6 months were stratified by postprocedure CK and CK-MB (multiple of the site’s upper normal limit).

Results. Overall, 1,779 patients (76%) had no CK-MB elevation; CK-MB levels were elevated to 1 to 3 times the upper normal limit in 323 patients (13.8%), to 3 to 5 times normal in 84 (3.6%), to 5 to 10 times normal in 86 (3.7%), and to >10 times normal in 69 patients (2.9%). Elevated CK-MB was associated with an increased risk of death, reinfarction, or emergency revascularization at 30 days, and of death, reinfarction, or surgical revascularization at 6 months. Elevated total CK to above three times normal was less frequent, but its prognostic significance paralleled that seen for CK-MB. The degree of risk correlated with the rise in CK or CK-MB, even for patients with successful procedures not complicated by abrupt closure.

Conclusions. Elevations in cardiac enzymes, including small increases (between one and three times normal) often not considered an infarction, are associated with an increased risk for short-term adverse clinical outcomes after successful or unsuccessful PCI.

Abbreviations and Acronyms
  CK-MB = creatine kinase (myocardial band isoenzyme)
  IMPACT-II = Integrilin (eptifibatide) to Minimize Platelet Aggregation and Coronary Thrombosis-II (trial)
  MI = myocardial infarction
  PCI = percutaneous coronary intervention




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