Clinical outcomes after detection of elevated cardiac enzymes in patients undergoing percutaneous intervention

Objectives. We examined the relations of elevated creatine kinase (CK) and its myocardial band isoenzyme (CK-MB) to clinical outcomes after percutaneo us coronary intervention (PCI) in patients enrolled in Integrilin (eptifiba tide) to Minimize Platelet Aggregation and Coronary Thrombosis-II (trial) ( IMPACT-II), a trial of the platelet glycoprotein IIb/IIIa inhibitor eptifib atide. Background. Elevation of cardiac enzymes often occurs after PCI, but its cl inical implications are uncertain. Methods. Patients undergoing elective, scheduled PCI for any indication mer e analyzed. Parallel analyses investigated CK (n = 3,535) and CK-MB (n = 2, 341) levels after PCI (within 4 to 20 h). Clinical outcomes at 30 days and 6 months mere stratified by postprocedure CK and CK-MB (multiple of the sit e's upper normal limit). Results. Overall, 1,779 patients (76%) had no CK-MB elevation; CK-MB levels were elevated to 1 to 3 times the upper normal limit in 323 patients (13.8 %), to 3 to 5 times normal in 84 (3.6%), to 5 to 10 times normal in 86 (3.7 %), and to >10 times normal in 69 patients (2.9%). Elevated CK-MD was assoc iated with an increased risk of death, reinfarction, or emergency revascula rization at 30 days, and of death, reinfarction, or surgical revascularizat ion at 6 months. Elevated total CK to above three times normal was less fre quent, but its prognostic significance paralleled that seen for CK-MB. The degree of risk correlated with the rise in CK or CK-MB, even for patients w ith successful procedures not complicated by abrupt closure. Conclusions. Elevations in cardiac enzymes, including small increases (betw een one and three times normal) often not considered an infarction, are ass ociated with an increased risk for short-term adverse clinical outcomes aft er successful or unsuccessful PCI. (C) 1998 by the American College of Card iology.