Open AccessThe contemporary value of peak creatine kinase‐ MB after ST ‐segment elevation myocardial infarction above other clinical and angiographic characteristics in predicting infarct size, left ventricular ejection fraction, and mortality
Author(s) -
Hartman Minke H. T.,
Eppinga Ruben N.,
Vlaar Pieter J. J.,
Lexis Chris P. H.,
Lipsic Erik,
Haeck Joost D. E.,
van Veldhuisen Dirk J.,
van der Horst Iwan C. C.,
van der Harst Pim
Publication year - 2017
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.22663
Subject(s) - medicine , ejection fraction , cardiology , myocardial infarction , creatine kinase , hazard ratio , percutaneous coronary intervention , ventricle , st segment , confidence interval , natriuretic peptide , cardiac magnetic resonance imaging , troponin , magnetic resonance imaging , heart failure , radiology
Background Complex multimarker approaches to predict outcome after ST ‐elevation myocardial infarction ( STEMI ) have only considered a single baseline sample, while neglecting easily obtainable peak creatine kinase and creatine kinase‐ MB ( CK‐MB ) values during hospitalization. Methods We studied 476 patients undergoing primary percutaneous coronary intervention for STEMI and cardiac magnetic resonance imaging ( CMRI ) at 4‐6 months after STEMI . We determined the association with cardiac biomarkers (peak CK‐MB , peak troponin T, N‐terminal pro‐brain natriuretic peptide), clinical and angiographic characteristics with infarct size, and LVEF , followed by association with mortality in 1120 STEMI patients. Results Peak CK‐MB was the strongest predictor for infarct size ( P <0.001, R 2 =0.60) and LVEF ( P <0.001, R 2 =0.40). The additional value of clinical and angiographic characteristics was limited. The optimal peak CK‐MB cutpoints, for differentiation among small (<10% of the left ventricle), moderate (≥10%–<30%), and large infarct size (≥30%), were 210 U/L and 380 U/L, respectively. These cutpoints were associated with 90‐day mortality; the hazard ratio for moderate infarct was 2.99 (95% confidence interval [CI]: 1.51‐5.93, P =0.002) and for large infarct 6.53 (95% CI: 3.63‐11.76, P <0.001). Conclusions Classical peak CK‐MB measured during hospitalization for STEMI was superior to other clinical and angiographic characteristics in predicting CMRI‐defined infarct size and LVEF, and should be included and validated in future multimarker studies. Peak CK‐MB cutpoints differentiated among infarct size categories and were associated with increased 90‐day mortality risk.