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INTERVENTIONAL CARDIOLOGY

Differential mortality risk of postprocedural creatine kinase-MB elevation following successful versus unsuccessful stent procedures

Allen Jeremias, MD^*,, Donald S. Baim, MD, FACC^*,, Kalon K.L. Ho, MD, MS, FACC^*,, Manish Chauhan, MD, FACC, Joseph P. Carrozza, Jr, MD, FACC^*, David J. Cohen, MD, MS^*,, Jeffrey J. Popma, MD, FACC, Richard E. Kuntz, MD, MS^*, and Donald E. Cutlip, MD, FACC^*,,*

^* Harvard Clinical Research Institute
Division of Cardiology, Beth Israel Deaconess Medical Center
Division of Cardiology, Brigham and Women's Hospital, Boston, Massachusetts, USA

Manuscript received March 17, 2004; revised manuscript received May 5, 2004, accepted June 7, 2004.

^* Reprint requests and correspondence: Dr. Donald E. Cutlip, Interventional Cardiology Section, Beth Israel Deaconess Medical Center, One Deaconess Road, Baker 4, Boston, Massachusetts 02215 (Email: dcutlip{at}bidmc.harvard.edu).

OBJECTIVES: This study was designed to evaluate the effect of periprocedural myocardial infarction (MI) on mortality according to success of the stent procedure.

BACKGROUND: The mortality effect of periprocedural MI relative to successful versus unsuccessful procedures has not been examined.

METHODS: All-cause mortality during the first year was evaluated prospectively among 5,850 patients from coronary stent clinical trials. Myocardial infarction was classified according to creatine kinase-MB level as type 1 (>1 but <3 times normal), type 2 (3 but 8 times normal), or type 3 (>8 times normal or Q-wave MI). Procedures were classified as successful unless there was a final diameter stenosis >50%; final Thrombolysis In Myocardial Infarction flow grade <3; final National Heart, Lung, and Blood Institute dissection grade D; repeat revascularization within 24 h; or stent thrombosis within 24 h.

RESULTS: Myocardial infarction was more frequent after unsuccessful procedures (69.6% vs. 20.4%, p < 0.001). Mortality during the first year was higher in patients with MI (2.8% vs. 1.7%, p = 0.01), but the effect was significant only for type 3 MI (4.7% vs. 1.7%, p = 0.008). Moreover, the mortality difference for any MI was confined to patients with unsuccessful procedures (13.1% vs. 0%, p = 0.03), with no significant effect among patients with otherwise successful procedures (2.1% vs. 1.7%, p > 0.20). The independent predictors of mortality were unsuccessful procedure (p < 0.001), diabetes mellitus (p = 0.001), history of prior MI (p = 0.003), multivessel disease (p = 0.006), and advancing age (p < 0.001), but not periprocedural MI.

CONCLUSIONS: The association of periprocedural MI with increased mortality during the first year following stent placement was confined to patients with unsuccessful procedures.

Abbreviations and Acronyms   CK-MB = creatine kinase-MB   MI = myocardial infarction   PCI = percutaneous coronary intervention

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