(Circulation. 1996;94:1528-1536.)
© 1996 American Heart Association, Inc.
Articles |
Significance of Mild Transient Release of Creatine Kinase–MB Fraction After Percutaneous Coronary Interventions
the Department of Cardiology, the Cleveland Clinic Foundation, Cleveland, Ohio.
Correspondence to Stephen G. Ellis, MD, Director, Sones Cardiac Cath Labs, The Cleveland Clinic Foundation, 9500 Euclid Ave, F-25, Cleveland, OH 44195 or to Alaa E. Abdelmeguid, MD, PhD, Henry Ford Medical Center, Cardiac Catheterization Laboratory (K-2), 2799 W Grand Blvd, Detroit, MI 48202.
Background The clinical significance of minor elevations in creatine kinase–myocardial band isoenzyme (CK-MB) after coronary interventions has not been systematically evaluated.
Methods and Results We examined 4484 patients who underwent successful percutaneous transluminal coronary angioplasty or directional coronary atherectomy and whose peak CK levels did not exceed twice the upper limit of laboratory normal. Group 1 (3776 patients) had no CK or MB elevation after the procedure (ie, CK 
180 IU/L, with MB fraction 4%). Group 2 (450 patients) had a peak CK level between 100 and 180 IU/L, with MB fraction >4%, and group 3 (258 patients) had a peak CK level between 181 and 360 IU/L, with MB fraction >4%. The strongest correlate of postprocedure CK-MB elevation was the performance of directional coronary atherectomy (odds ratio, 4.1; P<.0001), followed by the development of 
1 in-lab minor procedural complication (odds ratio, 2.6; P<.0001). Clinical follow-up was available in 4461 patients (99.5%), with a mean duration of 36±22 months. Survival analysis, adjusted with Cox proportional hazards regression model, showed that the groups with elevated CK-MB had a significantly higher incidence of cardiac death (risk ratio, 1.3; P=.04) and myocardial infarction (risk ratio, 1.3; P=.03). Major ischemic complications (death, myocardial infarction, and coronary revascularization) occurred more frequently in the groups with increased CK-MB (groups 1 versus 2 versus 3, 37.3% versus 43.3% versus 48.9%; P=.01).
Conclusions This study shows that minor elevations of CK-MB after successful coronary interventions identify a population with a worse long-term prognosis compared with patients with no enzyme elevations and appear to have an adverse effect on long-term prognosis. Future studies of percutaneous coronary revascularization should include routine measurements of biochemical cardiac markers as important predictors of long-term prognosis.
Key Words: creatine kinase • angioplasty • revascularization • enzymes
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N. S. Kleiman, A. M. Lincoff, G. C. Flaker, K. S. Pieper, R. G. Wilcox, L. G. Berdan, T. J. Lorenz, D. V. Cokkinos, M. L. Simoons, E. Boersma, et al. Early Percutaneous Coronary Intervention, Platelet Inhibition With Eptifibatide, and Clinical Outcomes in Patients With Acute Coronary Syndromes Circulation, February 22, 2000; 101(7): 751 - 757. [Abstract] [Full Text] [PDF]
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R. Mehran, G. Dangas, G. S. Mintz, A. J. Lansky, A. D. Pichard, L. F. Satler, K. M. Kent, G. W. Stone, and M. B. Leon Atherosclerotic Plaque Burden and CK-MB Enzyme Elevation After Coronary Interventions : Intravascular Ultrasound Study of 2256 Patients Circulation, February 15, 2000; 101(6): 604 - 610. [Abstract] [Full Text] [PDF]
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E. J. Topol and J. S. Yadav Recognition of the Importance of Embolization in Atherosclerotic Vascular Disease Circulation, February 8, 2000; 101(5): 570 - 580. [Full Text] [PDF]
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M. K. Hong, R. Mehran, G. Dangas, G. S. Mintz, A. J. Lansky, A. D. Pichard, K. M. Kent, L. F. Satler, G. W. Stone, and M. B. Leon Creatine Kinase-MB Enzyme Elevation Following Successful Saphenous Vein Graft Intervention Is Associated With Late Mortality Circulation, December 14, 1999; 100(24): 2400 - 2405. [Abstract] [Full Text] [PDF]
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A. Kini, J. D. Marmur, S. Kini, G. Dangas, T. P. Cocke, S. Wallenstein, E. Brown, J. A. Ambrose, and S. K. Sharma Creatine kinase-MB elevation after coronary intervention correlates with diffuse atherosclerosis, and low-to-medium level elevation has a benign clinical course: Implications for early discharge after coronary intervention J. Am. Coll. Cardiol., September 1, 1999; 34(3): 663 - 671. [Abstract] [Full Text] [PDF]
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W. K. Laskey Beneficial Impact of Preconditioning During PTCA on Creatine Kinase Release Circulation, April 27, 1999; 99(16): 2085 - 2089. [Abstract] [Full Text] [PDF]
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A. M. Lincoff, J. E. Tcheng, R. M. Califf, D. J. Kereiakes, T. A. Kelly, G. C. Timmis, N. S. Kleiman, J. E. Booth, C. Balog, C. F. Cabot, et al. Sustained Suppression of Ischemic Complications of Coronary Intervention by Platelet GP IIb/IIIa Blockade With Abciximab : One-Year Outcome in the EPILOG Trial Circulation, April 20, 1999; 99(15): 1951 - 1958. [Abstract] [Full Text] [PDF]
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J. Zimmerman, R. Fromm, D. Meyer, A. Boudreaux, C.-C. C. Wun, R. Smalling, B. Davis, G. Habib, and R. Roberts Diagnostic Marker Cooperative Study for the Diagnosis of Myocardial Infarction Circulation, April 6, 1999; 99(13): 1671 - 1677. [Abstract] [Full Text] [PDF]
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K.-C. Koch, J. vom Dahl, E. Kleinhans, H. G. Klues, P. W. Radke, S. Ninnemann, G. Schulz, U. Buell, and P. Hanrath Influence of a platelet GPIIb/IIIa receptor antagonist on myocardial hypoperfusion during rotational atherectomy as assessed by myocardial Tc-99m sestamibi scintigraphy J. Am. Coll. Cardiol., March 15, 1999; 33(4): 998 - 1004. [Abstract] [Full Text] [PDF]
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C. R. Narins, D. P. Miller, R. M. Califf, and E. J. Topol The relationship between periprocedural myocardial infarction and subsequent target vessel revascularization following percutaneous coronary revascularization: Insights from the EPIC trial J. Am. Coll. Cardiol., March 1, 1999; 33(3): 647 - 653. [Abstract] [Full Text] [PDF]
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R. N. Piana, W. H. Ahmed, B. Chaitman, P. Ganz, S. Kinlay, J. Strony, B. Adelman, J. A. Bittl, and on behalf of the Hirulog Angioplasty Study Investi Effect of transient abrupt vessel closure during otherwise successful angioplasty for unstable angina on clinical outcome at six months J. Am. Coll. Cardiol., January 1, 1999; 33(1): 73 - 78. [Abstract] [Full Text] [PDF]
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B. E. Tardiff, R. M. Califf, J. E. Tcheng, A. M. Lincoff, K. N. Sigmon, R. A. Harrington, K. W. Mahaffey, E. M. Ohman, P. S. Teirstein, J. C. Blankenship, et al. Clinical outcomes after detection of elevated cardiac enzymes in patients undergoing percutaneous intervention J. Am. Coll. Cardiol., January 1, 1999; 33(1): 88 - 96. [Abstract] [Full Text] [PDF]
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S. R. Steinhubl, M. S. Lauer, D. P. Mukherjee, D. J. Moliterno, A. M. Lincoff, S. G. Ellis, and E. J. Topol The duration of pretreatment with ticlopidine prior to stenting is associated with the risk of procedure-related non-Q-wave myocardial infarctions J. Am. Coll. Cardiol., November 1, 1998; 32(5): 1366 - 1370. [Abstract] [Full Text] [PDF]
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E. J. Topol and P. W. Serruys Frontiers in Interventional Cardiology Circulation, October 27, 1998; 98(17): 1802 - 1820. [Full Text] [PDF]
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I. Moussa, J. Moses, C. Di Mario, G. Busi, B. Reimers, Y. Kobayashi, R. Albiero, M. Ferraro, and A. Colombo Stenting After Optimal Lesion Debulking (SOLD) Registry : Angiographic and Clinical Outcome Circulation, October 20, 1998; 98(16): 1604 - 1609. [Abstract] [Full Text] [PDF]
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International, Randomized, Controlled Trial of Lamifiban (a Platelet Glycoprotein IIb/IIIa Inhibitor), Heparin, or Both in Unstable Angina Circulation, June 23, 1998; 97(24): 2386 - 2395. [Abstract] [Full Text] [PDF]
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R. Kornowski, R. Mehran, M. K. Hong, L. F. Satler, A. D. Pichard, K. M. Kent, G. S. Mintz, R. Waksman, J. R. Laird, A. J. Lansky, et al. Procedural Results and Late Clinical Outcomes After Placement of Three or More Stents in Single Coronary Lesions Circulation, April 14, 1998; 97(14): 1355 - 1361. [Abstract] [Full Text] [PDF]
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D. S. Baim, D. E. Cutlip, S. K. Sharma, K. K. L. Ho, R. Fortuna, T. L. Schreiber, R. L. Feldman, J. Shani, C. Senerchia, Y. Zhang, et al. Final Results of the Balloon vs Optimal Atherectomy Trial (BOAT) Circulation, February 3, 1998; 97(4): 322 - 331. [Abstract] [Full Text] [PDF]
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S. S. Khan, J. Forrester, G. Gambassi, R. Landolfi, R. Bernabei, A. M. Lincoff, E. J. Topol, R. M. Califf, and D. R. Holmes Platelet Glycoprotein IIb/IIIa Receptor Blockade after Coronary Angioplasty N. Engl. J. Med., October 23, 1997; 337(17): 1243 - 1245. [Full Text]
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E. J. Topol, J. J. Ferguson, H. F. Weisman, J. E. Tcheng, S. G. Ellis, N. S. Kleiman, R. J. Ivanhoe, A. L. Wang, D. P. Miller, K. M. Anderson, et al. Long-term Protection From Myocardial Ischemic Events in a Randomized Trial of Brief Integrin {beta}3 Blockade With Percutaneous Coronary Intervention JAMA, August 13, 1997; 278(6): 479 - 484. [Abstract] [PDF]
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D. L. Fischman and M. P. Savage The Platelet, the Patient, and Periprocedural Infarction During Percutaneous Transluminal Coronary Angioplasty JAMA, August 13, 1997; 278(6): 518 - 519. [Abstract] [PDF]
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The EPILOG Investigators Platelet Glycoprotein IIb/IIIa Receptor Blockade and Low-Dose Heparin during Percutaneous Coronary Revascularization N. Engl. J. Med., June 12, 1997; 336(24): 1689 - 1697. [Abstract] [Full Text] [PDF]
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E. M. Ohman and B. E. Tardiff Periprocedural Cardiac Marker Elevation After Percutaneous Coronary Artery Revascularization: Importance and Implications JAMA, February 12, 1997; 277(6): 495 - 497. [Abstract] [PDF]
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A. E. Abdelmeguid and E. J. Topol The Myth of the Myocardial `Infarctlet' During Percutaneous Coronary Revascularization Procedures Circulation, December 15, 1996; 94(12): 3369 - 3375. [Full Text]
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