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.
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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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