doi: 10.1161/hc0502.104278
(Circulation. 2002;105:554.)
© 2002 American Heart Association, Inc.
Brief Rapid Communications |
Minor Myocardial Damage and Prognosis
Are Spontaneous and Percutaneous Coronary Intervention–Related Events Different?
From Thoraxcenter (K.M.A., E.B., M.L.S.), University Hospital Rotterdam, The Netherlands; Duke University Medical Center (J.H.A., B.E.T., R.A.H.), Durham, NC; and Cleveland Clinic Foundation (A.M.L.), Cleveland, Ohio.
Correspondence to K. Martijn Akkerhuis, MD, PhD, Thoraxcenter, University Hospital Rotterdam, Room-H543, Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands. E-mail k.makkerhuis{at}freeler.nl
Background— The relevance of the adverse prognostic implications of CK-MB elevation after percutaneous coronary intervention (PCI) remains controversial. Therefore, we compared the relationship between the level of postprocedural CK-MB elevation and 6-month mortality in patients undergoing PCI with the relationship between the level of spontaneous, non–PCI-related CK-MB elevation and 6-month mortality in patients with acute coronary syndromes (ACS) treated medically.
Methods and Results— In the PURSUIT trial, 5583 of 9461 patients who presented with a non–ST-elevation ACS did not undergo PCI or CABG and had at least 1 CK-MB sample collected during index-hospitalization. There was a gradual increase in 6-month mortality with higher CK-MB levels: 4.1%, 8.6%, 9.0%, 14.3%, 15.5% for CK-MB ratios 0 to 1, >1 to 3, >3 to 5, >5 to 10, and >10 times the upper limit of normal. A combined analysis in 8838 patients undergoing PCI in 5 large, clinical trials revealed a proportional relationship between postprocedural CK-MB levels (
48 hours after PCI) and 6-month mortality. In patients with CK-MB ratios 0 to 1, >1 to 3, >3 to 5, >5 to 10, and >10, the risk of death was 1.3%, 2.0%, 2.3%, 4.3%, and 7.4%, respectively. The absolute mortality rates were lower after procedure-related infarcts compared with spontaneous infarcts. Yet, the relative increase in 6-month mortality with each increase in peak CK-MB level was similar for PCI-related myocardial necrosis and spontaneous myocardial necrosis, as all tests for heterogeneity of the odds ratios were nonsignificant.
Conclusions— The present analysis indicates that the adverse prognostic implications of periprocedural myocardial necrosis should be considered similar to the adverse consequences of spontaneous myocardial necrosis.
Key Words: angioplasty • creatine kinase • myocardial infarction • prognosis
This article has been cited by other articles:
 |
|
 |
|
  T. Uetani, T. Amano, H. Ando, K. Yokoi, K. Arai, M. Kato, N. Marui, M. Nanki, T. Matsubara, H. Ishii, et al. The correlation between lipid volume in the target lesion, measured by integrated backscatter intravascular ultrasound, and post-procedural myocardial infarction in patients with elective stent implantation Eur. Heart J., July 2, 2008; 29(14): 1714 - 1720. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 NACB WRITING GROUP MEMBERS, A. H.B. Wu, A. S. Jaffe, F. S. Apple, R. L. Jesse, G. L. Francis, D. A. Morrow, L. K. Newby, J. Ravkilde, W.H. W. Tang, et al. National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines: Use of Cardiac Troponin and B-Type Natriuretic Peptide or N-Terminal proB-Type Natriuretic Peptide for Etiologies Other than Acute Coronary Syndromes and Heart Failure Clin. Chem., December 1, 2007; 53(12): 2086 - 2096. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Thygesen, J. S. Alpert, H. D. White, and on behalf of the Joint ESC/ACCF/AHA/WHF Task Force Universal Definition of Myocardial Infarction J. Am. Coll. Cardiol., November 27, 2007; 50(22): 2173 - 2195. [Full Text] [PDF]
|
|
|
|
 |
|
 K. Thygesen, J. S. Alpert, H. D. White, on behalf of the Joint ESC/ACCF/AHA/WHF Task Force, TASK FORCE MEMBERS: Chairpersons: Kristian Thygese, Biomarker Group: Allan S. Jaffe, Coordinator (USA), ECG Group: Bernard Chaitman, Co-ordinator (USA), P, Imaging Group: Richard Underwood, Coordinator (UK), Intervention Group: Jean-Pierre Bassand, Co-ordina, Clinical Investigation Group: Paul W. Armstrong, C, et al. Universal Definition of Myocardial Infarction Circulation, November 27, 2007; 116(22): 2634 - 2653. [Full Text] [PDF]
|
|
|
|
|
|
Task Force Members, K. Thygesen, J. S. Alpert, H. D. White, Biomarker Group, A. S. Jaffe, F. S. Apple, M. Galvani, H. A. Katus, L. K. Newby, et al. Universal definition of myocardial infarction: Kristian Thygesen, Joseph S. Alpert and Harvey D. White on behalf of the Joint ESC/ACCF/AHA/WHF Task Force for the Redefinition of Myocardial Infarction Eur. Heart J., October 2, 2007; 28(20): 2525 - 2538. [Full Text] [PDF]
|
|
|
|
|
|
A. A. Bavry, D. J. Kumbhani, A. N. Rassi, D. L. Bhatt, and A. T. Askari Benefit of Early Invasive Therapy in Acute Coronary Syndromes: A Meta-Analysis of Contemporary Randomized Clinical Trials J. Am. Coll. Cardiol., October 3, 2006; 48(7): 1319 - 1325. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Levitsky Protecting the Myocardial Cell During Coronary Revascularization Circulation, July 4, 2006; 114(1_suppl): I-339 - I-343. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D Y Leung and J K French End points in clinical trials: are they moving the goalposts? Heart, July 1, 2006; 92(7): 870 - 872. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Herrmann Peri-procedural myocardial injury: 2005 update Eur. Heart J., December 1, 2005; 26(23): 2493 - 2519. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Cavallini and F. Chirillo Non-ST-elevation acute coronary syndromes management: a fresh look at glycoprotein IIb/IIIa inhibitors Eur. Heart J. Suppl., October 1, 2005; 7(suppl_K): K10 - K14. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. J. de Winter, F. Windhausen, J. H. Cornel, P. H.J.M. Dunselman, C. L. Janus, P. E.F. Bendermacher, H. R. Michels, G. T. Sanders, J. G.P. Tijssen, F. W.A. Verheugt, et al. Early Invasive versus Selectively Invasive Management for Acute Coronary Syndromes N. Engl. J. Med., September 15, 2005; 353(11): 1095 - 1104. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C-K Wong and H D White Implications of the new definition of myocardial infarction Postgrad. Med. J., September 1, 2005; 81(959): 552 - 555. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. L. Bhatt and E. J. Topol Periprocedural Cardiac Enzyme Elevation Predicts Adverse Outcomes Circulation, August 9, 2005; 112(6): 906 - 922. [Full Text] [PDF]
|
|
|
|
|
|
D. E. Cutlip and R. E. Kuntz Cardiac Enzyme Elevation After Successful Percutaneous Coronary Intervention Is Not an Independent Predictor of Adverse Outcomes Circulation, August 9, 2005; 112(6): 916 - 923. [Full Text] [PDF]
|
|
|
|
|
|
C. Cavallini, S. Savonitto, R. Violini, G. Arraiz, M. Plebani, Z. Olivari, P. Rubartelli, S. Battaglia, L. Niccoli, G. Steffenino, et al. Impact of the elevation of biochemical markers of myocardial damage on long-term mortality after percutaneous coronary intervention: results of the CK-MB and PCI study Eur. Heart J., August 1, 2005; 26(15): 1494 - 1498. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. G Katritsis Elevation of CK-MB following percutaneous coronary intervention Eur. Heart J., July 1, 2004; 25(13): 1180 - 1180. [Full Text] [PDF]
|
|
|
|
|
|
K A A Fox, J Birkhead, R Wilcox, C Knight, and J Barth British Cardiac Society Working Group on the definition of myocardial infarction Heart, June 1, 2004; 90(6): 603 - 609. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M.T. Roe, K.W. Mahaffey, R. Kilaru, J.H. Alexander, K.M. Akkerhuis, M.L. Simoons, R.A. Harrington, B.E. Tardiff, C.B. Granger, E.M. Ohman, et al. Creatine kinase-MB elevation after percutaneous coronary intervention predicts adverse outcomes in patients with acute coronary syndromes Eur. Heart J., February 2, 2004; 25(4): 313 - 321. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. K French and H. D White Clinical implications of the new definition of myocardial infarction Heart, January 1, 2004; 90(1): 99 - 106. [Full Text] [PDF]
|
|
|
|
|
|
P O Collinson and P J Stubbs Are troponins confusing? Heart, November 1, 2003; 89(11): 1285 - 1287. [Full Text] [PDF]
|
|
|
|
|
|
J. P. A. Ioannidis, E. Karvouni, and D. G. Katritsis Mortality risk conferred by small elevations of creatine kinase-MB isoenzyme after percutaneous coronary intervention J. Am. Coll. Cardiol., October 15, 2003; 42(8): 1406 - 1411. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. J. White Angiographic predictors of adverse outcomes in the modern interventional era J. Am. Coll. Cardiol., September 17, 2003; 42(6): 989 - 990. [Full Text] [PDF]
|
|
|
|
|
|
F. W. Wang, A. Osman, J. Otero, G. A. Stouffer, S. Waxman, A. Afzal, A. Anzuini, and B. F. Uretsky Distal Myocardial Protection During Percutaneous Coronary Intervention With an Intracoronary {beta}-Blocker Circulation, June 17, 2003; 107(23): 2914 - 2919. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Holmvang, P. Clemmensen, B. Lindahl, B. Lagerqvist, P. Venge, G. Wagner, L. Wallentin, and P. Grande Quantitative analysis of the admission electrocardiogram identifies patients with unstable coronary artery disease who benefit the most from early invasive treatment J. Am. Coll. Cardiol., March 19, 2003; 41(6): 905 - 915. [Abstract] [Full Text] [PDF]
|
|