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Minimal myocardial damage during coronary intervention is associated with impaired outcome

M.L. Simoons, M. van den Brand, M. Lincoff, R. Harrington, R. van der Wieken, A. Vahanian, W. Rutsch, J. Kootstra, E. Boersma, R.M. Califf, E. Topol
DOI: http://dx.doi.org/10.1053/euhj.1999.1521 1112-1119 First published online: 1 August 1999

Abstract

Aims Studies on the glycoprotein IIb-IIIa receptor blocker abciximab in patients undergoing percutaneous coronary intervention consistently show a reduction in procedure-related myocardial infarction. Some such infarcts are characterized by elevated creatine kinase or creatine kinase-MB, without apparent clinical symptoms. The clinical relevance of such ‘creatine kinase leaks’ has been questioned. Therefore we investigated the relationship between post-procedural creatine kinase-MB elevation and outcome at the 6 month follow-up.

Methods and Results Creatine kinase-MB, or total creatine kinase values were analysed in 5025 out of 6156 patients enrolled in the CAPTURE, EPIC and EPILOG studies. A consistent gradual increase in 6 month mortality was observed as creatine kinase-MB or creatine kinase levels increased: 1·1%, 2·1%, 1·8%, 3·6% and 6·7% for creatine-MB or creatine ratios (relative to upper limit of normal) <1, 1–3, 3–5, 5–10 and ≥10, respectively. Also the incidence of death or (recurrent) myocardial infarction was related to creatine kinase-MB or creatine kinase ratios. Subsequent revascularization was not related to periprocedural myocardial infarction. By multivariable analysis, correcting for clinical and angiographic characteristics, mortality at 6 months was related to the enzyme (creatine kinase, creatine kinase-MB) ratio, a history of heart failure and age. The combined end-point of death and myocardial infarction was also related to these factors, as well as to a history of bypass surgery and unstable angina.

Conclusion Modest elevation of cardiac enzymes (creatine kinase-MB, creatine kinase) after percutaneous coronary intervention is associated with an increased risk of mortality and reinfarction during the 6 month follow-up. Measures to reduce such periprocedural infarcts are warranted.

  • PTCA, abciximab, creatine kinase-MB, myocardial infarction, follow-up