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European Heart Journal Advance Access published online on January 31, 2007
European Heart Journal, doi:10.1093/eurheartj/ehl483
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© The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

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

Kenneth W. Mahaffey1,*, Matthew T. Roe1, Rakhi Kilaru1, John H. Alexander1, Frans Van de Werf2, Robert M. Califf2, Maarten L. Simoons3, Eric J. Topol4 and Robert A. Harrington1

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.

* 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


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