Long-term clinical events following creatine kinase-myocardial band isoenzyme elevation after successful coronary stenting

OBJECTIVEWe sought to evaluate the impact of intermediate creatine kinase-m yocardial band isoenzyme (CK-MB) elevation on late clinical outcomes in pat ients undergoing successful stent implantation in native coronary arteries. BACKGROUND Elevations of CK-MB after percutaneous coronary interventions ar e frequent. An association between high level of CK-R MB elevation (>5 time s normal) and late mortality after balloon and new device angioplasty has b een reported previously. However, significant controversy remains on the lo ng-term clinical importance of lower CK-MB elevations: (one to five times n ormal) after percutaneous coronary revascularization. Moreover, the inciden ce and prognostic importance of cardiac enzyme elevation after coronary ste nting have not been well established. METHODS Prospectively collected data from 900 consecutive patients (1,213 l esions) undergoing successful stenting in native vessels were analyzed. Bas ed on the CK-MB levels after coronary stenting, patients were classified in to three groups: normal group 1 (n = 585), elevation of > 1 to 5 times norm al group 2 (n = 238) and elevation of >5 times normal group 3 (n = 77). RESULTS Patients in group 3 had more in-hospital recurrent ischemia (p = 0. 001) and pulmonary edema (p = 0.01) than patients in groups 1 and 2. Long-t erm clinical end points were similar between groups 1 and 2. However, patie nts in group 3 had an increased incidence of late mortality compared with p atients in groups 2 and 1 (6.9%, 1.2% and 1.7%, respectively, p = 0.01). Mu ltivariate analysis showed that patients with CK-MB >5 rimes normal after c oronary stenting had an increased risk of major adverse clinical events (re lative risk: 1.70, p < 0.05) and death (relative risk: 3.25, p < 0.05) that was not observed in patients with lower CK-MB rise. CONCLUSIONS Patients with CK-MB elevation >5 times normal had higher late m ortality and more unfavorable event-free survival than those patients with normal or lower CK-MB rise after coronary stenting. While intermediate CK-M B elevation (>1 to 5 times normal) is frequent after coronary stenting (26% ), this was not associated with an increased risk of late mortality or majo r adverse clinical events, (J Am Coll Cardiol 2000;35:1134-41) (C) 2000 by the American College of Cardiology.