Creatine kinase-MB elevation after coronary intervention correlates with diffuse atherosclerosis, and low-to-medium level elevation has a benign clinical course: Implications for early discharge after coronary intervention

Annapoorna Kini, Jonathan D. Marmur, Subhash Kini, George Dangas, Thomas P. Cocke, Sylvan Wallenstein, Eppie Brown, John A. Ambrose, Samin K. Sharma

Research output: Contribution to journalArticlepeer-review

128 Scopus citations

Abstract

OBJECTIVES: The study evaluated the incidence and predictors of creatine kinase-MB isoenzyme (CK-MB) elevation after successful coronary intervention using current devices, and assessed the influence on in-hospital course and midterm survival. BACKGROUND: The CK-MB elevation after coronary intervention predominantly using balloon angioplasty correlates with late cardiac events of myocardial infarction (MI) and death, whether CK-MB elevation after nonballoon devices is associated with an adverse short and midterm prognosis is unknown. METHODS: The incidence and predictors of CK-MB elevation after coronary intervention were prospectively studied in 1,675 consecutive patients and were followed for in-hospital events and survival. RESULTS: CK- MB elevation was detected in 313 patients (18.7%), with 1-3X in 12,8%, 3-5X in 3.5% and >5X normal in 2.4% of patients. Procedural complications or electrocardiogram changes occurred in only 49% of the CK-MB-elevation cases; CK-MB elevation was more common after nonballoon devices (19.5% vs. 11.5% after percutaneous transluminal coronary angioplasty, p < 0.01). Predictors of CK-MB elevation on multivariate analysis were diffuse coronary disease (p = 0.02), systemic atherosclerosis (p = 0.002), stent use (p = 0.04) and absence of beta-blocker therapy (p = 0.001). Adverse in-hospital cardiac events were more frequent in patients with >5X CK-MB elevation, with no significant difference between 1-5X CK-MB elevation versus normal CK-MB group. During a mean follow-up of 13 ± 3 months, the incidence of death in the CK-MB-elevation group was 1.6% versus 1.3% in the normal CK-MB group (p = NS). CONCLUSIONS: The CK-MB elevation after coronary intervention was observed even in the absence of discernible procedural complications and was more common in patients with diffuse atherosclerosis. In-hospital clinical events requiring prolonged monitoring were higher in >5X CK-MB-elevation patients only. Midterm survival of CK-MB-elevation patients was similar to those with normal CK-MB. Our prospective analysis shows a lack of adverse in- hospital cardiac events and suggests that early discharge of stable 1-5 X normal CK-MB-elevation patients after successful coronary intervention is safe.

Original languageEnglish
Pages (from-to)663-671
Number of pages9
JournalJournal of the American College of Cardiology
Volume34
Issue number3
DOIs
StatePublished - Sep 1999
Externally publishedYes

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