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Prognostic value of recurrent episodes of creatine kinase‐MB elevation following repeated catheter‐based coronary interventions
Author(s) -
Kornowski Ran,
Fuchs Shmuel,
Hong Mun K.,
Mehran Roxana,
Satler Lowell F.,
Pichard Augusto D.,
Kent Kenneth M.,
Stone Gregg W.,
Leon Martin B.
Publication year - 2000
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/1522-726x(200010)51:2<131::aid-ccd1>3.0.co;2-h
Subject(s) - medicine , conventional pci , cardiology , creatine kinase , percutaneous coronary intervention , st segment , revascularization , confidence interval , myocardial infarction , surgery
Abstract Creatine kinase‐MB (CK‐MB) enzyme elevations were shown to affect cardiac prognosis following percutaneous coronary interventions (PCIs). This study examined whether recurrent episodes of CK‐MB elevation following repeated PCIs may be associated with a cumulative adverse prognostic risk. We studied 767 consecutive patients (age, 64 ± 11 years; 69% male) who underwent two consecutive PCI procedures on two separate hospitalizations (mean interval, 121 ± 110 days). Patients were stratified into four groups according to number of episodes of any (> 4 ng/ml) postinterventional CK‐MB rise (no elevation, previously elevated, currently elevated, or elevated at the time of both procedures; n = 403, 107, 153, and 104 patients, respectively). In‐hospital clinical outcomes (death, Q‐MI, and repeat revascularization) and up to 1‐year follow‐up events were obtained. Recurrent episodes of CK‐MB elevation were associated with increased in‐hospital mortality (3.8% vs. 0.9% vs. 0% vs. 0%, P = 0.0003), increased cumulative mortality (18.9% vs. 5.9% vs. 4.3% vs. 4.3%, P = 0.0003) and cumulative Q wave MI (8.0% vs. 4.9% vs. 1.0% vs. 0.8%, P = 0.005) at 1 year, and lower overall cardiac event‐free survival at follow‐up (66.8% vs. 80.5% vs. 88.8% vs. 88.8%, P = 0.0001 for patients with twice, current, previous, and no CK‐MB elevation, respectively). By multivariate analysis, CK‐MB elevated at the time of both procedures, was the strongest independent predictor for cumulative mortality (OR 3.4, 95% CI 1.6–7.1, P = 0.001) or any adverse cardiac events (OR 2.6, 95% CI 1.6–4.3, P = 0.0002). We conclude that cumulative episodes of periprocedural CK‐MB elevation are associated with an incremental adverse prognostic risk including mortality and Q‐wave MI. Thus, measures aimed at reducing subsequent CK‐MB rise may be warranted in particular among patients with a prior history of PCI related CK‐MB elevation. Cathet. Cardiovasc. Intervent. 51:131–137, 2000. © 2000 Wiley‐Liss, Inc.