Abstract 11061: Pooled Analysis of 24,428 Patients with Myocardial Infarction Associated with Percutaneous Coronary Intervention
Background: High level of creatine kinase-myocardial band isoenzyme (CK-MB) elevation has been associated with late mortality after percutaneous coronary intervention (PCI). While there is consensus that extensive cardiac enzyme elevation increase mortality significantly, there is uncertainty about the exact clinical impact of smaller CK-MB elevations. We performed a meta-analysis to assess whether different degrees of CK-MB elevation after PCI affect the subsequent risk of death.
Methods: The published literature was scanned by formal searches of electronic databases such as PubMed and MEDLINE from January 1999 to April 2011. Risk ratio (RR) was used as summary estimate. The pooled effects were calculated using random effects models (DerSimonian and Laird method).
Results: Seven studies have been included totaling 24,428 patients who underwent PCI (6,889 patients with CK-MB elevation and 17,539 patients without CK-MB elevation). Mean follow-up duration for each study ranged from 6 to 36 months. Compared with patients without CK-MB elevation, there was a dose-response relationship with RR for death being 1.48 (95% confidence interval [CI], 1.14 to 1.92, p=0.003) with one- to three-fold CK-MB elevation, 1.75 (95% CI, 1.10 to 2.78, p=0.02) with three- to five-fold CK-MB elevation, and 2.62 (95% CI, 1.80 to 3.82, p<0.001) with over five-fold CK-MB elevation.
Conclusions: Any increase in CK-MB level after PCI was associated with significantly higher risk of late mortality in this updated meta-analysis. Efforts to routinely monitor periprocedural CK-MB level may help to improve the long-term clinical outcomes following PCI.
- © 2011 by American Heart Association, Inc.