European Heart Journal Advance Access originally published online on January 31, 2007
European Heart Journal 2007 28(4):425-432; doi:10.1093/eurheartj/ehl483
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Creatine kinase-MB elevation after coronary artery bypass grafting surgery in patients with non-ST-segment elevation acute coronary syndromes predict worse outcomes: results from four large clinical trials
1 Duke Clinical Research Institute, PO Box 17969, Durham, NC 27715, USA
2 Catholic University Hospital, Leuven, Belgium
3 Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
4 Cleveland Clinic Foundation, Cleveland, OH, USA
Received 3 October 2005; revised 14 November 2006; accepted 3 January 2007; online publish-ahead-of-print 31 January 2007.
* Corresponding author. Tel: +1 919 668 8845; fax: +1 919 668 7059. E-mail address: mahaf002{at}mc.duke.edu
AIMS: To assess the significance of creatine kinase (CK)-MB elevations in outcomes of patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS) who have undergone coronary artery bypass grafting (CABG) surgery.
METHODS AND RESULTS: This analysis includes data from 26 465 patients with NSTE ACS enrolled in four major trials. In total, 4626 (17.5%) of patients had CABG within 30 days. Patients were excluded if CK-MB was elevated within 24 h before surgery and there was no CK-MB measured after surgery. Overall, 4401 patients were included in these analyses. The incidence of mortality increased with peak CK-MB ratios of 0–1, > 1–3, > 3–5, > 5–10, and > 10 x the upper limit of normal measured at the local lab (P < 0.001 across categories): 1.1, 2.8, 2.4, 3.1, and 10.8% in hospital; 1.1, 3.0, 2.9, 3.5, and 10.2% at 30 days; and 1.6, 4.4, 4.7, 6.0, and 10.9% at 180 days. Multivariable predictors of 6-month mortality included age, heart rate and randomization, peak CK-MB ratio, time to CABG, prior angina, signs of congestive heart failure and randomization, three- and two-vessel coronary disease, enrolment infarction, ST-segment depression at enrolment, female sex, experimental treatment, and systolic blood pressure.
CONCLUSION: CK-MB elevations after CABG are independently associated with increased risk of mortality in patients with NSTE ACS.
Key Words: Creatine kinase-MB elevation • Coronary artery bypass graft • Acute coronary syndrome • Myocardial infarction • Clinical endpoints
This paper was guest edited by Prof. Antonio Colombo, EMO Centro Cuore Columbus, Columbus Hospital, Milan, Italy