| Minor myocardial damage and prognosis: are spontaneous and percutaneous coronary intervention-related events different? | |
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MedLine Citation:
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PMID: 11827918 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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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:
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Type: Journal Article |
Journal Detail:
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Title: Circulation Volume: 105 ISSN: 1524-4539 ISO Abbreviation: Circulation Publication Date: 2002 Feb |
Date Detail:
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Created Date: 2002-02-05 Completed Date: 2002-02-12 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0147763 Medline TA: Circulation Country: United States |
Other Details:
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Languages: eng Pagination: 554-6 Citation Subset: AIM; IM |
Affiliation:
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Thoraxcenter, University Hospital Rotterdam, The Netherlands. k.makkerhuis@freeler.nl |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Angioplasty, Transluminal, Percutaneous Coronary
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adverse effects*,
statistics & numerical data Coronary Artery Disease / blood, diagnosis, mortality*, therapy* Creatine Kinase / blood Creatine Kinase, MB Form Follow-Up Studies Humans Isoenzymes / blood Myocardial Infarction / etiology*, mortality* Myocardium / enzymology Odds Ratio Peptides / therapeutic use Platelet Aggregation Inhibitors / therapeutic use Postoperative Period Predictive Value of Tests Prognosis Randomized Controlled Trials as Topic / statistics & numerical data Retrospective Studies Risk Assessment Survival Analysis Survival Rate |
| Chemical | |
Reg. No./Substance:
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0/Isoenzymes; 0/Peptides; 0/Platelet Aggregation Inhibitors; 0/eptifibatide; EC 2.7.3.2/Creatine Kinase; EC 2.7.3.2/Creatine Kinase, MB Form |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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