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Prognostic Implications of Creatine Kinase Elevation After Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction

Amir Halkin, MD^_*, Gregg W. Stone, MD, FACC^,_*, Cindy L. Grines, MD, FACC, David A. Cox, MD, FACC, Barry D. Rutherford, MD, FACC^||, Paolo Esente, MD, FACC^¶, Carol M. Meils, MD, FACC^#, Per Albertsson, MD, FACC^_**, Anthony Farah, MD, FACC, James E. Tcheng, MD, FACC, Alexandra J. Lansky, MD, FACC^_*, and Roxana Mehran, MD, FACC^_*,

^_* Cardiovascular Research Foundation, New York, New York
Columbia University Medical Center, New York, New York
William Beaumont Hospital, Royal Oak, Michigan
Mid Carolina Cardiology, Charlotte, North Carolina
^|| St. Luke’s Hospital, Kansas City, Missouri
^¶ St. Joseph’s Hospital, Syracuse, New York
^# St. Joseph Regional Medical Center, Milwaukee, Wisconsin
^_** Sahlgrenska University Hospital, Göteborg, Sweden
Allegheny General Hospital, Pittsburgh, Pennsylvania
Duke Clinical Research Institute, Durham, North Carolina

View larger version (47K): [in a new window]   Figure 1 Mean creatine kinase (CK) levels and the timing of peak levels in patients stratified by CKpeak. (Top) CK levels at baseline and after percutaneous coronary intervention (PCI). *p trend < 0.0001 for all comparisons within individual time points. (Bottom) proportion of patients with CKpeak occurring at time point. p trend < 0.0001 for all within-group comparisons.

View larger version (32K): [in a new window]   Figure 2 Creatine kinase (CK) levels in patients stratified by randomization arm. PCI = percutaneous coronary intervention; PTCA = percutaneous transluminal coronary angioplasty.

View larger version (28K): [in a new window]   Figure 3 Creatine kinase (CK) levels at baseline and after percutaneous coronary intervention (PCI) in patients who survived (open bars) compared with those who had died (solid bars) by one-year follow-up. Data are presented as mean ± SD. (Top) All patients (n = 1,529). (Bottom) Patients with TIMI flow grade 3 after percutaneous coronary intervention (n = 1,448).

View larger version (15K): [in a new window]   Figure 4 All-cause mortality among patients stratified by peak creatine kinase (CKpeak) levels.

View larger version (25K): [in a new window]   Figure 5 Correlation between peak creatine kinase (CKpeak) and absolute left ventricular ejection fraction measured at seven months (top) and the improvement in left ventricular ejection fraction from baseline to seven months (bottom).