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The prognostic value of creatine kinase elevations extends across the whole spectrum of acute coronary syndromes

Stefano Savonitto, MD^*,*, Christopher B. Granger, MD, FACC, Diego Ardissino, MD, Laura Gardner, BSPH, Claudio Cavallini, MD^||, Marcello Galvani, MD^¶, Filippo Ottani, MD^#, Harvey D. White, DSc, FACC^**, Paul W. Armstrong, MD, FACC, E. Magnus Ohman, MD, FACC, Karen S. Pieper, MSc, Robert M. Califf, MD, FACC, Eric J. Topol, MD, FACC GUSTO-IIb Investigators

^* Department of Cardiology, Niguarda Hospital, Milan, Italy
Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
Division of Cardiology, Ospedali Riuniti di Parma, Parma, Italy
Duke Clinical Research Institute, Durham, North Carolina, USA
^|| Division of Cardiology, Presidio Ospedaliero Ca’ Foncello, Treviso, Italy
^¶ Division of Cardiology, Ospedale Morgagni-Pierantoni, Forlí, Italy
^# Division of Cardiology, Ospedale Civile, Bentivoglio, Italy
^** Cardiology Department, Green Lane Hospital, Auckland, New Zealand
Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
Department of Cardiology, Cleveland Clinic, Cleveland, Ohio, USA

View larger version (18K): [in a new window]   Figure 1 Distribution of patients for each end point. CK = creatine kinase; MI = myocardial infarction.

View larger version (34K): [in a new window]   Figure 2 Percentages of patients with creatine kinase (CK) ratios of 0 to 1, >1 to 2, >2 to 5 and >5 within 16 h from hospital admission in the total study population and in the cohorts with ST-segment elevation and non–ST-segment elevation on the admission electrocardiogram.

View larger version (19K): [in a new window]   Figure 3 Time course of (re)myocardial infarction (MI) after the index hospital admission in the ST-segment elevation and non–ST-segment elevation cohorts.

View larger version (23K): [in a new window]   Figure 4 Curves of the predicted probabilities averaged across all patients and adjusted for previously determined baseline covariates. Curves show the relationships between creatine kinase (CK) ratio and adjusted probability of death or death and (re)myocardial infarction (MI) at six months. A and B refer to the entire study population, which is split according to ST-segment presentation on the admission electrocardiogram (ECG) in C and D. No statistically significant interaction with ECG strata was observed after correcting for the significant prognostic predictors.

View larger version (15K): [in a new window]   Figure 5 (A) Adjusted odds ratios for six-month death in the total study population (11,725). No statistically significant interaction with electrocardiographic (ECG) strata was observed after correcting for the significant prognostic predictors (chi-square 63.04, p < 0.0001). (B) Adjusted odds ratio for six-month death and (re)myocardial infarction (MI) in the total study population (11,667). No statistically significant interaction with ECG strata was observed after correcting for the significant prognostic predictors (chi-square 55.48, p < 0.0001). CK = creatine kinase.