Copyright © 2004 by the European Society of Cardiology.
Clinical research
Creatine kinase-MB elevation after percutaneous coronary intervention predicts adverse outcomes in patients with acute coronary syndromes
a Duke Clinical Research Institute, Durham, North Carolina, USA
b University Hospital, Rotterdam, The Netherlands
c Cleveland Clinic Foundation, Cleveland, Ohio, USA
d University of Alberta, Edmonton, Canada
e Catholic University Hospital, Leuven, Belgium
f University of Kentucky, Lexington, Kentucky, USA
* Correspondence to: Matthew T. Roe, MD, MHS, Duke Clinical Research Institute, P.O. Box 17969, Durham, NC 27715 USA. Tel: +919-668-8959; fax: +919-668-7059
E-mail address: roe00001{at}mc.duke.edu
Received 20 February 2003; revised 9 October 2003; accepted 4 December 2003 This paper was guest edited by Prof. Bernard J. Gersh, Mayo Clinic
Abstract
Aim To study the relationship between outcomes and peak creatine kinase (CK)-MB levels after percutaneous coronary intervention (PCI) in patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS).
Methods and results Peak CK-MB ratios (peak CK-MB level/upper limit of normal [ULN]) after PCI were analysed in 6164 patients with NSTE ACS from four randomized trials who underwent in-hospital PCI. We excluded 696 patients with elevated CK or CK-MB levels <24h before PCI; the primary analysis included 2384 of the remaining 5468 patients (43.6%) with CK-MB levels measured 
24h after PCI. The incidence of in-hospital heart failure (0.1%, 0.8%, 3.4%, 4.1%, and 6.1%; P<0.001), arrhythmias (0.8%, 1.9%, 6.9%, 4.1%, and 7.9%; P<0.001), cardiogenic shock (0.1%, 1.3%, 2.0%, 2.3%, and 2.6%; P=0.004), and mortality through 6 months (2.1%, 2.4%, 4.9%, 4.1%, and 5.7%, P=0.005) was increased with peak CK-MB ratios of 0–1, 1–3, 3–5, 5–10, and >10xULN, respectively. The continuous peak CK-MB ratio after PCI significantly predicted adjusted 6-month mortality (risk ratio, 1.06 per unit increase above ULN; 95% confidence interval, 1.01–1.11; P=0.017).
Conclusions Greater CK-MB elevation after PCI is independently associated with adverse outcomes in NSTE ACS. These results underscore the adverse implications of elevated CK-MB levels after PCI in this high-risk population.
Key Words: Acute coronary syndromes • Prognosis • Creatine kinase • Biomarkers • Percutaneous coronaryinterventions
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