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ARTICLE

Long-term clinical events following creatine kinase–myocardial band isoenzyme elevation after successful coronary stenting

Jorge F. Saucedo, MD^*, Roxana Mehran, MD, FACC, FESC, George Dangas, MD, FACC, FESC, Mun K. Hong, MD, FACC, Alexandra Lansky, MD, Kenneth M. Kent, MD, PhD, FACC, FESC, Lowell F. Satler, MD, FACC, Augusto D. Pichard, MD, FACC, Gregg W. Stone, MD, FACC and Martin B. Leon, MD, FACC

^* Departments of Internal Medicine (Cardiology Divisions) of the University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
Washington Hospital Center, Washington, DC, USA

Manuscript received November 9, 1998; revised manuscript received October 21, 1999, accepted December 15, 1999.

Reprint requests and correspondence: Dr. Martin B. Leon, Cardiovascular Research Foundation, 110 Irving Street NW, Suite 4B-1, Washington, DC 20010
MBL1{at}mhg.edu

OBJECTIVE

We sought to evaluate the impact of intermediate creatine kinase–myocardial band isoenzyme (CK-MB) elevation on late clinical outcomes in patients undergoing successful stent implantation in native coronary arteries.

BACKGROUND

Elevations of CK-MB after percutaneous coronary interventions are frequent. An association between high level of CK-MB elevation (>5 times normal) and late mortality after balloon and new device angioplasty has been reported previously. However, significant controversy remains on the long-term clinical importance of lower CK-MB elevations (one to five times normal) after percutaneous coronary revascularization. Moreover, the incidence and prognostic importance of cardiac enzyme elevation after coronary stenting have not been well established.

METHODS

Prospectively collected data from 900 consecutive patients (1,213 lesions) undergoing successful stenting in native vessels were analyzed. Based on the CK-MB levels after coronary stenting, patients were classified into three groups: normal group 1 (n = 585), elevation of >1 to 5 times normal group 2 (n = 238) and elevation of >5 times normal group 3 (n = 77).

RESULTS

Patients in group 3 had more in-hospital recurrent ischemia (p = 0.001) and pulmonary edema (p = 0.01) than patients in groups 1 and 2. Long-term clinical end points were similar between groups 1 and 2. However, patients in group 3 had an increased incidence of late mortality compared with patients in groups 2 and 1 (6.9%, 1.2% and 1.7%, respectively, p = 0.01). Multivariate analysis showed that patients with CK-MB >5 times normal after coronary stenting had an increased risk of major adverse clinical events (relative risk: 1.70, p < 0.05) and death (relative risk: 3.25, p < 0.05) that was not observed in patients with lower CK-MB rise.

CONCLUSIONS

Patients with CK-MB elevation >5 times normal had higher late mortality and more unfavorable event-free survival than those patients with normal or lower CK-MB rise after coronary stenting. While intermediate CK-MB elevation (>1 to 5 times normal) is frequent after coronary stenting (26%), this was not associated with an increased risk of late mortality or major adverse clinical events.

Abbreviations and Acronyms   ANOVA = analysis of variance   BOAT = Balloon versus optimal Atherectomy Trial   CABG = coronary artery bypass grafting   CAVEAT = Coronary Angioplasty versus Excisional Atherectomy Trial   CK = creatine kinase   CK-MB = CK-myocardial band isoenzyme   EAST = Emory Angioplasty versus Surgical Trial   MI = myocardial infarction   PTCA = percutaneous transluminal coronary angioplasty   RR = relative risk   STARS = Stent Anti-Thrombotic Regimen Study   STRATAS = Study to determine Rotablator and Transluminal Angioplasty Strategy   TIMI = Thrombolysis in Myocardial Infarction

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