Abstract 3519: Periprocedural Myonecrosis is Associated with Adverse Cardiac Events after Drug-Eluting Stents Implantation
Background: High level of creatine kinase myocardial band isoenzyme (CK-MB) elevation has been associated with late mortality after coronary intervention. We sought to evaluate the impact of periprocedural myonecrosis on clinical events in patients undergoing drug-eluting stents (DESs) implantation.
Methods: A total of 1,807 consecutive patients (2,550 lesions) with successful DESs implantation were followed for mean duration of 13 ± 7 months. Patients with acute myocardial infarction were excluded. Based on the CK-MB levels after stenting, patients were classified into three groups: group I: normal CK-MB (n = 1,429, 79.1%), group II: 1 to 5 times normal CK-MB (n = 263, 14.6%), and group III: = 5 times normal CK-MB (n = 115, 6.4%). Major adverse cardiac events (MACE) were defined as death, myocardial infarction, and target lesion revascularization.
Results: There were no significant differences in baseline clinical characteristics between the three groups. Patients with elevated CK-MB levels showed longer stent length, more number of stents per lesion, and smaller postintervention minimal luminal diameter. With increasing levels of periprocedural CK-MB, there was an increased incidence of MACE (4.7% in group I vs. 6.5% in group II vs. 11.3% in group III, p = 0.002) and death (0.6% in group I vs. 1.5% in group II vs. 3.5% in group III, p = 0.012). By multivariate analysis, periprocedural peak CK-MB level was independent predictor of MACE (HR 1.01, 95% CI 1.00 to 1.02; p = 0.041) and death (HR 1.02, 95% CI 1.00 to 1.04; p = 0.049) in addition to left ventricular ejection fraction, cutting angioplasty, and number of stents per lesion.
Conclusions: Periprocedural myonecrosis was significantly associated with subsequent adverse clinical events after DESs implantation.