This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kini, A. Articles by Sharma, S. K. Search for Related Content PubMed PubMed Citation Articles by Kini, A. Articles by Sharma, S. K.

CLINICAL STUDIES

Creatine kinase-MB elevation after coronary intervention correlates with diffuse atherosclerosis, and low-to-medium level elevation has a benign clinical course

Implications for early discharge after coronary intervention

^a Cardiac Catheterization Laboratory of the Zena and Michael A. Weiner Cardiovascular Institute, Mount Sinai Hospital, New York, New York, USA

Manuscript received December 30, 1998; revised manuscript received April 7, 1999, accepted June 3, 1999.

Reprint requests and correspondence: Dr. Samin K. Sharma, Mount Sinai Hospital, Box 1030, One Gustave L. Levy Place, New York, New York 10029-6574
samin_sharma{at}smtplink.mssm.edu

OBJECTIVES

The study evaluated the incidence and predictors of creatine kinase–MB isoenzyme (CK-MB) elevation after successful coronary intervention using current devices, and assessed the influence on in-hospital course and midterm survival.

BACKGROUND

The CK-MB elevation after coronary intervention predominantly using balloon angioplasty correlates with late cardiac events of myocardial infarction (MI) and death. Whether CK-MB elevation after nonballoon devices is associated with an adverse short and midterm prognosis is unknown.

METHODS

The incidence and predictors of CK-MB elevation after coronary intervention were prospectively studied in 1,675 consecutive patients and were followed for in-hospital events and survival.

RESULTS

CK-MB elevation was detected in 313 patients (18.7%), with 1–3x in 12.8%, 3–5x in 3.5% and >5x normal in 2.4% of patients. Procedural complications or electrocardiogram changes occurred in only 49% of the CK-MB-elevation cases; CK-MB elevation was more common after nonballoon devices (19.5% vs. 11.5% after percutaneous transluminal coronary angioplasty; p < 0.01). Predictors of CK-MB elevation on multivariate analysis were diffuse coronary disease (p = 0.02), systemic atherosclerosis (p = 0.002), stent use (p = 0.04) and absence of beta-blocker therapy (p = 0.001). Adverse in-hospital cardiac events were more frequent in patients with >5x CK-MB elevation, with no significant difference between 1–5x CK-MB elevation versus normal CK-MB group. During a mean follow-up of 13 ± 3 months, the incidence of death in the CK-MB-elevation group was 1.6% versus 1.3% in the normal CK-MB group (p = NS).

CONCLUSIONS

The CK-MB elevation after coronary intervention was observed even in the absence of discernible procedural complications and was more common in patients with diffuse atherosclerosis. In-hospital clinical events requiring prolonged monitoring were higher in >5x CK-MB-elevation patients only. Midterm survival of CK-MB-elevation patients was similar to those with normal CK-MB. Our prospective analysis shows a lack of adverse in-hospital cardiac events and suggests that early discharge of stable 1–5x normal CK-MB-elevation patients after successful coronary intervention is safe.

Abbreviations and Acronyms   ACC/AHA = American College of Cardiology/American Heart Association   CABG = coronary artery bypass grafting   CCS = Canadian Cardiovascular Society   CHF = congestive heart failure   CK-MB = creatine kinase–MB isoenzyme   ECG = electrocardiogram   IAMP = intra-aortic balloon pump   LAD = left anterior descending artery   LVEF = left ventricular ejection fraction   MI = myocardial infarction   PRCA = percutaneous rotational coronary atherectomy   PTCA = percutaneous transluminal coronary angioplasty   RCA = right coronary artery   SVG = saphenous vein graft   TIMI = thrombolysis in myocardial infarction   TLR = target lesion revascularization

This article has been cited by other articles:

				A. Prasad, B. J. Gersh, M. E. Bertrand, A. M. Lincoff, J. W. Moses, E. M. Ohman, H. D. White, S. J. Pocock, B. T. McLaurin, D. A. Cox, et al. Prognostic significance of periprocedural versus spontaneously occurring myocardial infarction after percutaneous coronary intervention in patients with acute coronary syndromes: an analysis from the ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) trial. J. Am. Coll. Cardiol., July 28, 2009; 54(5): 477 - 486. [Abstract] [Full Text] [PDF]

				Y. J. Hong, G. S. Mintz, S. W. Kim, S. Y. Lee, T. Okabe, A. D. Pichard, L. F. Satler, R. Waksman, K. M. Kent, W. O. Suddath, et al. Impact of Plaque Composition on Cardiac Troponin Elevation After Percutaneous Coronary Intervention: An Ultrasound Analysis J. Am. Coll. Cardiol. Img., April 1, 2009; 2(4): 458 - 468. [Abstract] [Full Text] [PDF]

				A. Prasad, C. S. Rihal, R. J. Lennon, M. Singh, A. S. Jaffe, and D. R. Holmes Jr Significance of Periprocedural Myonecrosis on Outcomes After Percutaneous Coronary Intervention: An Analysis of Preintervention and Postintervention Troponin T Levels in 5487 Patients Circ Cardiovasc Interv, August 1, 2008; 1(1): 10 - 19. [Abstract] [Full Text] [PDF]

				Y. J. Hong, M. H. Jeong, Y. Ahn, D. S. Sim, J. W. Chung, J. S. Cho, N. S. Yoon, H. J. Yoon, J. Y. Moon, K. H. Kim, et al. Plaque prolapse after stent implantation in patients with acute myocardial infarction an intravascular ultrasound analysis. J. Am. Coll. Cardiol. Img., July 1, 2008; 1(4): 489 - 497. [Abstract] [Full Text] [PDF]

				A. Prasad, M. Singh, A. Lerman, R. J. Lennon, D. R. Holmes Jr, and C. S. Rihal Isolated Elevation in Troponin T After Percutaneous Coronary Intervention Is Associated With Higher Long-Term Mortality J. Am. Coll. Cardiol., November 7, 2006; 48(9): 1765 - 1770. [Abstract] [Full Text] [PDF]

				J. Herrmann Peri-procedural myocardial injury: 2005 update Eur. Heart J., December 1, 2005; 26(23): 2493 - 2519. [Abstract] [Full Text] [PDF]

				T Nageh, R A Sherwood, B M Harris, and M R Thomas Prognostic role of cardiac troponin I after percutaneous coronary intervention in stable coronary disease Heart, September 1, 2005; 91(9): 1181 - 1185. [Abstract] [Full Text] [PDF]

				D. L. Bhatt and E. J. Topol Periprocedural Cardiac Enzyme Elevation Predicts Adverse Outcomes Circulation, August 9, 2005; 112(6): 906 - 922. [Full Text] [PDF]

				D. E. Cutlip and R. E. Kuntz Cardiac Enzyme Elevation After Successful Percutaneous Coronary Intervention Is Not an Independent Predictor of Adverse Outcomes Circulation, August 9, 2005; 112(6): 916 - 923. [Full Text] [PDF]

				C. Cavallini, S. Savonitto, R. Violini, G. Arraiz, M. Plebani, Z. Olivari, P. Rubartelli, S. Battaglia, L. Niccoli, G. Steffenino, et al. Impact of the elevation of biochemical markers of myocardial damage on long-term mortality after percutaneous coronary intervention: results of the CK-MB and PCI study Eur. Heart J., August 1, 2005; 26(15): 1494 - 1498. [Abstract] [Full Text] [PDF]

				W.-H. Chen, P.-Y. Lee, W. Ng, H.-F. Tse, and C.-P. Lau Is aspirin resistance or female gender associated with a high incidence of myonecrosis after nonurgent percutaneous coronary intervention? Reply J. Am. Coll. Cardiol., February 15, 2005; 45(4): 636 - 636. [Full Text] [PDF]

				C. Briguori, A. Colombo, F. Airoldi, A. Violante, A. Focaccio, P. Balestrieri, P. Paolo Elia, B. Golia, S. Lepore, G. Riviezzo, et al. Statin administration before percutaneous coronary intervention: impact on periprocedural myocardial infarction Eur. Heart J., October 2, 2004; 25(20): 1822 - 1828. [Abstract] [Full Text] [PDF]

				I. Iakovou, G. S. Mintz, G. Dangas, A. Abizaid, R. Mehran, Y. Kobayashi, A. J. Lansky, E. D. Aymong, E. Nikolsky, G. W. Stone, et al. Increased CK-MB release is a "trade-off" for optimal stent implantation: an intravascular ultrasound study J. Am. Coll. Cardiol., December 3, 2003; 42(11): 1900 - 1905. [Abstract] [Full Text] [PDF]

				D. O. Williams A twist in our understanding of enzyme elevation after coronary intervention J. Am. Coll. Cardiol., December 3, 2003; 42(11): 1906 - 1908. [Full Text] [PDF]

				B. K. Nallamothu and E. R. Bates Periprocedural myocardial infarction and mortality: Causality versus association J. Am. Coll. Cardiol., October 15, 2003; 42(8): 1412 - 1414. [Full Text] [PDF]

				R. A. Henderson, S. J. Pocock, T. C. Clayton, R. Knight, K. A. A. Fox, D. G. Julian, D. A. Chamberlain, and Second Randomized Intervention Treatment of Angina Seven-year outcome in the RITA-2 trial: coronary angioplasty versus medical therapy J. Am. Coll. Cardiol., October 1, 2003; 42(7): 1161 - 1170. [Abstract] [Full Text] [PDF]

				J. R. Kizer, M. R. Muttrej, W. H. Matthai, J. McConnell, H. Nardone, A. F. Sonel, M. G. Keane, and R. L. Wilensky Role of cardiac troponin T in the long-term risk stratification of patients undergoing percutaneous coronary intervention Eur. Heart J., July 2, 2003; 24(14): 1314 - 1322. [Abstract] [Full Text] [PDF]

				A. S. Kini, P. Lee, C. A. Mitre, M. E. Duffy, and S. K. Sharma Postprocedure chest pain after coronary stenting: implications on clinical restenosis J. Am. Coll. Cardiol., January 1, 2003; 41(1): 33 - 38. [Abstract] [Full Text] [PDF]

				S. G. Ellis, D. Chew, A. Chan, P. L. Whitlow, J. P. Schneider, and E. J. Topol Death Following Creatine Kinase-MB Elevation After Coronary Intervention: Identification of an Early Risk Period: Importance of Creatine Kinase-MB Level, Completeness of Revascularization, Ventricular Function, and Probable Benefit of Statin Therapy Circulation, September 3, 2002; 106(10): 1205 - 1210. [Abstract] [Full Text] [PDF]

				J Herrmann, C von Birgelen, M Haude, L Volbracht, N Malyar, H Eggebrecht, T F M Konorza, D Baumgart, and R Erbel Prognostic implication of cardiac troponin T increase following stent implantation Heart, June 1, 2002; 87(6): 549 - 553. [Abstract] [Full Text] [PDF]

				D. R. Holmes Jr and P. B. Berger Troponisms, Necrosettes, Enzyme Leaks, Creatinine Phosphokinase Bumps, and Infarctlets: What's Behind This New Lexicon and What Does It Add? Circulation, August 7, 2001; 104(6): 627 - 629. [Full Text] [PDF]

				M. S. Chauhan, R. E. Kuntz, K. K. L. Ho, D. J. Cohen, J. J. Popma, J. P. Carrozza Jr, D. S. Baim, and D. E. Cutlip Coronary artery stenting in the aged J. Am. Coll. Cardiol., March 1, 2001; 37(3): 856 - 862. [Abstract] [Full Text] [PDF]