Minimal myocardial damage during coronary intervention is associated with impaired outcome

Aims Studies on the glycoprotein IIb-IIIa receptor blocker abciximab in pat ients undergoing percutaneous coronary intervention consistently show a red uction in procedure-related myocardial infarction. Some such infarcts are c haracterized by elevated creatine kinase or creatine kinase-MB, without app arent clinical symptoms. The clinical relevance of such 'creatine kinase le aks' has been questioned. Therefore we investigated the relationship betwee n postprocedural creatine kinase-MB elevation and outcome at the 6 month fo llow-up. Methods and Results Creatine kinase-MB, or total creatine kinase values wer e analysed in 5025 out of 6156 patients enrolled in the CAPTURE, EPIC and E PILOG studies. A consistent gradual increase in 6 month mortality was obser ved as creatine kinase-MB or creatine kinase levels increased: 1.1%, 2.1%, 1.8%, 3.6% and 6.7% for creatine-MB or creatine ratios (relative to upper l imit of normal) <1, 1-3, 3-5, 5-10 and greater than or equal to 10, respect ively. Also the incidence of death or (recurrent) myocardial infarction was related to creatine kinase-MB or creatine kinase ratios. Subsequent revasc ularization was not related to peri-procedural myocardial infarction. By mu ltivariable analysis, correcting for clinical and angiographic characterist ics, mortality at 6 months was related to the enzyme (creatine kinase, crea tine kinase-MB) ratio, a history of heart failure and age. The combined end -point of death and myocardial infarction was also related to these factors , as well as to a history of bypass surgery and unstable angina. Conclusion Modest elevation of cardiac enzymes (creatine kinase-MB, creatin e kinase) after percutaneous coronary intervention is associated with an in creased risk of mortality and reinfarction during the 6 month follow-up. Me asures to reduce such periprocedural infarcts are warranted.