Document Detail

Minor myocardial damage and prognosis: are spontaneous and percutaneous coronary intervention-related events different?
MedLine Citation:
PMID:  11827918     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The relevance of the adverse prognostic implications of CK-MB elevation after percutaneous coronary intervention (PCI) remains controversial. Therefore, we compared the relationship between the level of postprocedural CK-MB elevation and 6-month mortality in patients undergoing PCI with the relationship between the level of spontaneous, non-PCI-related CK-MB elevation and 6-month mortality in patients with acute coronary syndromes (ACS) treated medically. METHODS AND RESULTS: In the PURSUIT trial, 5583 of 9461 patients who presented with a non-ST-elevation ACS did not undergo PCI or CABG and had at least 1 CK-MB sample collected during index-hospitalization. There was a gradual increase in 6-month mortality with higher CK-MB levels: 4.1%, 8.6%, 9.0%, 14.3%, 15.5% for CK-MB ratios 0 to 1, >1 to 3, >3 to 5, >5 to 10, and >10 times the upper limit of normal. A combined analysis in 8838 patients undergoing PCI in 5 large, clinical trials revealed a proportional relationship between postprocedural CK-MB levels (</= 48 hours after PCI) and 6-month mortality. In patients with CK-MB ratios 0 to 1, >1 to 3, >3 to 5, >5 to 10, and >10, the risk of death was 1.3%, 2.0%, 2.3%, 4.3%, and 7.4%, respectively. The absolute mortality rates were lower after procedure-related infarcts compared with spontaneous infarcts. Yet, the relative increase in 6-month mortality with each increase in peak CK-MB level was similar for PCI-related myocardial necrosis and spontaneous myocardial necrosis, as all tests for heterogeneity of the odds ratios were nonsignificant. CONCLUSIONS: The present analysis indicates that the adverse prognostic implications of periprocedural myocardial necrosis should be considered similar to the adverse consequences of spontaneous myocardial necrosis.
K Martijn Akkerhuis; John H Alexander; Barbara E Tardiff; Eric Boersma; Robert A Harrington; A Michael Lincoff; Maarten L Simoons
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Circulation     Volume:  105     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2002 Feb 
Date Detail:
Created Date:  2002-02-05     Completed Date:  2002-02-12     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  554-6     Citation Subset:  AIM; IM    
Thoraxcenter, University Hospital Rotterdam, The Netherlands.
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MeSH Terms
Angioplasty, Transluminal, Percutaneous Coronary / adverse effects*,  statistics & numerical data
Coronary Artery Disease / blood,  diagnosis,  mortality*,  therapy*
Creatine Kinase / blood
Creatine Kinase, MB Form
Follow-Up Studies
Isoenzymes / blood
Myocardial Infarction / etiology*,  mortality*
Myocardium / enzymology
Odds Ratio
Peptides / therapeutic use
Platelet Aggregation Inhibitors / therapeutic use
Postoperative Period
Predictive Value of Tests
Randomized Controlled Trials as Topic / statistics & numerical data
Retrospective Studies
Risk Assessment
Survival Analysis
Survival Rate
Reg. No./Substance:
0/Isoenzymes; 0/Peptides; 0/Platelet Aggregation Inhibitors; 0/eptifibatide; EC Kinase; EC Kinase, MB Form

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