CLINICAL STUDY
Association between CK-MB elevation after percutaneous or surgical revascularization and three-year mortality
Sorin J. Brener, MD, FACC*,*,
Bruce W. Lytle, MD, FACC ,
Jakob P. Schneider, RN*,
Stephen G. Ellis, MD, FACC* and
Eric J. Topol, MD, FACC*
* Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio USA
Cardiothoracic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
Manuscript received February 26, 2002;
revised manuscript received May 7, 2002,
accepted July 15, 2002.
* Reprint requests and correspondence: Dr. Sorin J. Brener, Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk F- 25, Cleveland, Ohio 44195, USA.
breners{at}ccf.org
OBJECTIVES: The goal of this study was to assess the long-term impact of creatine kinase-MB isoform (CK-MB) elevation after percutaneous or surgical revascularization.
BACKGROUND: The long-term impact of CK-MB elevation after coronary artery bypass grafting (CABG) is not as well characterized as that following percutaneous coronary intervention (PCI).
METHODS: The three-year cumulative survival of consecutive patients who underwent their first percutaneous or surgical revascularization procedure between January 1, 1995 and August 31, 2000 and had CK-MB determination was assessed using the Social Security Death Index.
RESULTS: The 3,812 patients undergoing CABG had a less favorable coronary risk profile than the 3,573 patients undergoing PCI. The incidence of CK-MB elevation above normal range was 90% and 38% for the CABG and PCI groups (p < 0.001). In 6% and 5%, respectively, the elevation surpassed 10x the upper limit of normal (ULN). At an average follow-up of three years, there were 712 deaths, 83 of which occurred within 30 days of procedure. The cumulative survival was 92% and 90% for CABG and PCI, respectively (p = 0.003). Chronic renal insufficiency (adjusted hazard ratio [HR] 3.8, [95% confidence interval 3.1 to 4.6]), age (HR 1.5 per decade [1.3 to 1.6]), ejection fraction <40% (HR 1.3 [1.1 to 1.5] and PCI (HR 1.6 [1.3 to 1.9]) were the main predictors of increased mortality. Creatine kinase-MB isoform elevation only above 10 x ULN was independently predictive of mortality in the CABG (HR 1.3 [1.1 to 1.5]) and PCI (HR 1.1 [1.0 to 1.2]) groups, p < 0.001.
CONCLUSIONS: Creatine kinase MB isoform elevation after revascularization is very common, particularly in CABG patients. When extensive, it is independently correlated with increased mortality over a three-year period. Identification and aggressive management of patients with high levels of CK-MB after revascularization may improve their outcome.
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Abbreviations and Acronyms
| | ARTS | | Arterial Revascularization Therapy Study | | CABG | | coronary artery bypass grafting | | CAD | | coronary artery disease | | CI | | confidence interval | | CK-MB | | creatine kinase-MB isoform | | HR | | hazard ratio | | MI | | myocardial infarction | | PCI | | percutaneous coronary intervention | | SSDI | | Social Security Death Index | | ULN | | upper limit of normal |
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