Prognostic implications of creatine kinase-mb elevation after percutaneous coronary intervention: Results from the evaluation of drug-eluting stents and ischemic events (EVENT) registry

Jason B. Lindsey, Kevin F. Kennedy, Joshua M. Stolker, Ian C. Gilchrist, Debabrata Mukherjee, Steven P. Marso, Michael J. Pencina, Neal S. Kleiman, David J. Cohen

Research output: Contribution to journalArticle

32 Scopus citations

Abstract

Background-Creatine kinase-MB (CK-MB) elevation after percutaneous coronary intervention (PCI) has been associated with increased risk for mortality. Although most studies have defined periprocedural myocardial infarction (pMI) as an elevation in CK-MB >3 × upper limit of normal (ULN), use of different CK-MB assays and variation in site-specific definitions of the ULN may limit the value of such relative thresholds. Methods and Results-We used data from the multicenter Evaluation of Drug-Eluting Stents and Ischemic Events (EVENT) registry to examine the impact of variations in site-specific thresholds for CK-MB elevation on the incidence of pMI as well as the relationship between absolute peak levels of CK-MB after PCI and 1-year mortality. The study cohort consisted of 6347 patients who underwent nonemergent PCI and had normal CK-MB at baseline. Across the 59 study centers, the ULN for CK-MB ranged from 2.6 to 10.4 ng/mL (median, 5.0 ng/mL), and there was an inverse relationship between the site-specific ULN and the incidence of pMI (defined as CK-MB elevation >3 × ULN). Although any postprocedure elevation of CK-MB was associated with an adverse prognosis, in categorical analyses, only CK-MB ≥ 50 ng/mL was independently associated with increased 1-year mortality (hazard ratio, 4.71; 95% confidence interval, 2.42 to 9.13; P<0.001). Spline analysis using peak CK-MB as a continuous variable suggested a graded, nonlinear relationship with 1-year mortality, with an inflection point at ≈ 30 ng/mL. Conclusions-Among unselected patients undergoing PCI, there is a graded relationship between CK-MB elevation after PCI and 1-year mortality that is particularly strong for large CK-MB elevations (>30 to 50 ng/mL). Future studies that include pMI as a clinical end point should consider using a core laboratory to assess CK-MB (to ensure consistency) and raising the threshold for defining pMI above current levels (to enhance clinical relevance).

Original languageEnglish (US)
Pages (from-to)474-480
Number of pages7
JournalCirculation: Cardiovascular Interventions
Volume4
Issue number5
DOIs
StatePublished - Oct 1 2011

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Keywords

  • Creatine kinase
  • Mortality prognosis
  • Myonecrosis
  • Percutaneous coronary intervention

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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