Death following creatine kinase-MB elevation after coronary intervention: Identification of an early risk period: Importance of creatine kinase-MB level, completeness of revascularization, ventricular function, and probable benefit of statin therapy

Stephen G. Ellis, Derek Chew, Albert Chan, Patrick L. Whitlow, Jakob P. Schneider, Eric J. Topol

Research output: Contribution to journalArticle

189 Citations (Scopus)

Abstract

Background - Creatine kinase (CK)-MB elevation after percutaneous coronary intervention (PCI) has been associated with subsequent cardiac death. The patients at risk, the timing of risk, and potential treatment implications are uncertain. Methods and Results - Eight thousand, four hundred nine consecutive non-acute myocardial infarction patients with successful PCI and no emergency surgery or Q-wave myocardial infarction were followed for 38±25 months; 1446 (17.2%) had post-PCI CK-MB above normal on routine ascertainment. Patients were prospectively stratified into those with CK-MB 1 to 5x or CK-MB >5x normal. No patient with CK-MB 1 to 5x normal died during the first week after PCI, and excess risk of early death for patients with CK-MB elevation occurred primarily in the first 3 to 4 months. The actuarial 4-month risk of death was 8.9%, 1.9%, and 1.2% for patients with CK-MB >5x, CK-MB 1 to 5x, and CK-MB ≤1x normal (P<0.001). Death within 4 months was independently correlated with the degree of CK-MB elevation, creatinine ≥2 mg%, post-PCI C-reactive protein, low ejection fraction, age, and congestive heart failure class (P<0.01 for all). In a matched subset analysis, incomplete revascularization (P<0.001), congestive heart failure class (P=0.005), and no statin treatment at hospital discharge (P=0.009) were associated with death. Conclusions - Patients with CK-MB elevation after PCI are at excess risk of death for 3 to 4 months, although prolonging hospitalization for CK-MB 1 to 5x is unlikely to modify risk. CK-MB >5x normal, incomplete revascularization, elevated C-reactive protein, heart failure, the elderly, and hospital discharge without on statin therapy increases risk. Several of these factors suggest that inflammation may play a part in the excess risk of death.

LanguageEnglish
Pages1205-1210
Number of pages6
JournalCirculation
Volume106
Issue number10
DOIs
Publication statusPublished - 3 Sep 2002
Externally publishedYes

Keywords

  • Angioplasty
  • Myocardial infarction
  • Proteins

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

@article{6de76c8a9a05463ca8f7d711ad3df7a5,
title = "Death following creatine kinase-MB elevation after coronary intervention: Identification of an early risk period: Importance of creatine kinase-MB level, completeness of revascularization, ventricular function, and probable benefit of statin therapy",
abstract = "Background - Creatine kinase (CK)-MB elevation after percutaneous coronary intervention (PCI) has been associated with subsequent cardiac death. The patients at risk, the timing of risk, and potential treatment implications are uncertain. Methods and Results - Eight thousand, four hundred nine consecutive non-acute myocardial infarction patients with successful PCI and no emergency surgery or Q-wave myocardial infarction were followed for 38±25 months; 1446 (17.2{\%}) had post-PCI CK-MB above normal on routine ascertainment. Patients were prospectively stratified into those with CK-MB 1 to 5x or CK-MB >5x normal. No patient with CK-MB 1 to 5x normal died during the first week after PCI, and excess risk of early death for patients with CK-MB elevation occurred primarily in the first 3 to 4 months. The actuarial 4-month risk of death was 8.9{\%}, 1.9{\%}, and 1.2{\%} for patients with CK-MB >5x, CK-MB 1 to 5x, and CK-MB ≤1x normal (P<0.001). Death within 4 months was independently correlated with the degree of CK-MB elevation, creatinine ≥2 mg{\%}, post-PCI C-reactive protein, low ejection fraction, age, and congestive heart failure class (P<0.01 for all). In a matched subset analysis, incomplete revascularization (P<0.001), congestive heart failure class (P=0.005), and no statin treatment at hospital discharge (P=0.009) were associated with death. Conclusions - Patients with CK-MB elevation after PCI are at excess risk of death for 3 to 4 months, although prolonging hospitalization for CK-MB 1 to 5x is unlikely to modify risk. CK-MB >5x normal, incomplete revascularization, elevated C-reactive protein, heart failure, the elderly, and hospital discharge without on statin therapy increases risk. Several of these factors suggest that inflammation may play a part in the excess risk of death.",
keywords = "Angioplasty, Myocardial infarction, Proteins",
author = "Ellis, {Stephen G.} and Derek Chew and Albert Chan and Whitlow, {Patrick L.} and Schneider, {Jakob P.} and Topol, {Eric J.}",
year = "2002",
month = "9",
day = "3",
doi = "10.1161/01.CIR.0000028146.71416.2E",
language = "English",
volume = "106",
pages = "1205--1210",
journal = "Circulation",
issn = "0009-7322",
publisher = "Lippincott Williams and Wilkins",
number = "10",

}

Death following creatine kinase-MB elevation after coronary intervention : Identification of an early risk period: Importance of creatine kinase-MB level, completeness of revascularization, ventricular function, and probable benefit of statin therapy. / Ellis, Stephen G.; Chew, Derek; Chan, Albert; Whitlow, Patrick L.; Schneider, Jakob P.; Topol, Eric J.

In: Circulation, Vol. 106, No. 10, 03.09.2002, p. 1205-1210.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Death following creatine kinase-MB elevation after coronary intervention

T2 - Circulation

AU - Ellis, Stephen G.

AU - Chew, Derek

AU - Chan, Albert

AU - Whitlow, Patrick L.

AU - Schneider, Jakob P.

AU - Topol, Eric J.

PY - 2002/9/3

Y1 - 2002/9/3

N2 - Background - Creatine kinase (CK)-MB elevation after percutaneous coronary intervention (PCI) has been associated with subsequent cardiac death. The patients at risk, the timing of risk, and potential treatment implications are uncertain. Methods and Results - Eight thousand, four hundred nine consecutive non-acute myocardial infarction patients with successful PCI and no emergency surgery or Q-wave myocardial infarction were followed for 38±25 months; 1446 (17.2%) had post-PCI CK-MB above normal on routine ascertainment. Patients were prospectively stratified into those with CK-MB 1 to 5x or CK-MB >5x normal. No patient with CK-MB 1 to 5x normal died during the first week after PCI, and excess risk of early death for patients with CK-MB elevation occurred primarily in the first 3 to 4 months. The actuarial 4-month risk of death was 8.9%, 1.9%, and 1.2% for patients with CK-MB >5x, CK-MB 1 to 5x, and CK-MB ≤1x normal (P<0.001). Death within 4 months was independently correlated with the degree of CK-MB elevation, creatinine ≥2 mg%, post-PCI C-reactive protein, low ejection fraction, age, and congestive heart failure class (P<0.01 for all). In a matched subset analysis, incomplete revascularization (P<0.001), congestive heart failure class (P=0.005), and no statin treatment at hospital discharge (P=0.009) were associated with death. Conclusions - Patients with CK-MB elevation after PCI are at excess risk of death for 3 to 4 months, although prolonging hospitalization for CK-MB 1 to 5x is unlikely to modify risk. CK-MB >5x normal, incomplete revascularization, elevated C-reactive protein, heart failure, the elderly, and hospital discharge without on statin therapy increases risk. Several of these factors suggest that inflammation may play a part in the excess risk of death.

AB - Background - Creatine kinase (CK)-MB elevation after percutaneous coronary intervention (PCI) has been associated with subsequent cardiac death. The patients at risk, the timing of risk, and potential treatment implications are uncertain. Methods and Results - Eight thousand, four hundred nine consecutive non-acute myocardial infarction patients with successful PCI and no emergency surgery or Q-wave myocardial infarction were followed for 38±25 months; 1446 (17.2%) had post-PCI CK-MB above normal on routine ascertainment. Patients were prospectively stratified into those with CK-MB 1 to 5x or CK-MB >5x normal. No patient with CK-MB 1 to 5x normal died during the first week after PCI, and excess risk of early death for patients with CK-MB elevation occurred primarily in the first 3 to 4 months. The actuarial 4-month risk of death was 8.9%, 1.9%, and 1.2% for patients with CK-MB >5x, CK-MB 1 to 5x, and CK-MB ≤1x normal (P<0.001). Death within 4 months was independently correlated with the degree of CK-MB elevation, creatinine ≥2 mg%, post-PCI C-reactive protein, low ejection fraction, age, and congestive heart failure class (P<0.01 for all). In a matched subset analysis, incomplete revascularization (P<0.001), congestive heart failure class (P=0.005), and no statin treatment at hospital discharge (P=0.009) were associated with death. Conclusions - Patients with CK-MB elevation after PCI are at excess risk of death for 3 to 4 months, although prolonging hospitalization for CK-MB 1 to 5x is unlikely to modify risk. CK-MB >5x normal, incomplete revascularization, elevated C-reactive protein, heart failure, the elderly, and hospital discharge without on statin therapy increases risk. Several of these factors suggest that inflammation may play a part in the excess risk of death.

KW - Angioplasty

KW - Myocardial infarction

KW - Proteins

UR - http://www.scopus.com/inward/record.url?scp=0037015263&partnerID=8YFLogxK

U2 - 10.1161/01.CIR.0000028146.71416.2E

DO - 10.1161/01.CIR.0000028146.71416.2E

M3 - Article

VL - 106

SP - 1205

EP - 1210

JO - Circulation

JF - Circulation

SN - 0009-7322

IS - 10

ER -