European Heart Journal Advance Access originally published online on March 1, 2005
European Heart Journal 2005 26(15):1494-1498; doi:10.1093/eurheartj/ehi173
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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
1Ospedale Ca' Foncello, Divisione di Cardiologia, Piazza Ospedale 1, 31100 Treviso, Italy
2Department of Cardiology, Niguarda Hospital, Milan, Italy
3Department of Interventional Cardiology, San Camillo Hospital, Rome, Italy
4Astra-Zeneca Spa, Milan, Italy
5Laboratory of Clinical Chemistry, University Hospital, Padua, Italy
6Division of Cardiology, San Martino Hospital, Genoa, Italy
7Department of Interventional Cardiology, Montevergine Hospital, Avellino, Italy
8Division of Cardiology, Civil Hospital, Brescia, Italy
9Division of Cardiology, Santa Croce Hospital, Cuneo, Italy
10Division of Cardiology, Maggiore Hospital, Parma, Italy
Received 4 September 2004; revised 11 January 2005; accepted 20 January 2005; online publish-ahead-of-print 1 March 2005.
* Corresponding author. Tel: +39 0422 322767; fax: +39 0422 322662. E-mail address: clcaval{at}tin.it
Aims Retrospective studies and post hoc analyses have suggested that mild elevations in the creatine kinase-MB (CK-MB) isoenzyme following percutaneous coronary intervention (PCI) may be associated with an increased risk of death in the long term. However, this finding is still controversial, and the prognostic significance of elevations of more sensitive markers of myocardial damage, such as the cardiac troponins, has not been established. In this multicentre prospective cohort study, we evaluated the influence of post-procedural elevations of CK-MB and troponin I (cTnI) on long-term mortality.
Methods and results The CK-MB and PCI study included 3494 consecutive patients undergoing PCI from February 2000 to October 2000 in 16 Italian tertiary centres. Blood samples were collected at baseline, and at 812 and 1824 h after the procedure, and were analysed in a core biochemistry laboratory. CK-MB elevation was detected in 16% of the patients, and was associated with increased 2-year mortality [7.2 vs. 3.8%; odds ratio (OR): 1.9; 95% confidence interval (CI): 1.32.8; P<0.001). The degree of CK-MB elevation (peak CK-MB ratio) independently predicted the risk of death (adjusted OR per unit: 1.04; 95% CI: 1.011.07; P=0.009). A cTnI elevation was detected in 44.2% of the cases and was not associated with a significant increase in mortality (4.9 vs. 4.0%; OR: 1.2; 95% CI: 0.91.7; P=0.2).
Conclusion Post-procedural elevations of CK-MB, but not cTnI, influence 2-year mortality.
Key Words: Angioplasty Stents Complications Enzymes Prognosis
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