Creatine kinase elevations after coronary interventions

Introduction and objectives. Percutaneous revascularization has led to an i mportant change in the treatment of patients with symptomatic ischemic hear t disease in recent years. There is controversy concerning the incidence an d prognostic significance of postprocedural increases in creatine kinase. T he aim of this study was to assess the incidence of these elevations and th e related factors and to observe the prognosis of patients with and without creatin kinase elevations. Methods. We reviewed 447 patients in whom an angioplasty was done in our de partment from January 1997 to June 1998, excluding 138 patients with myocar dial infarction in the previous four days or unsuccessful angioplasty. Crea tine kinase was measured in all patients at 0, 4, 8 and 24 hours after angi oplasty. We analyzed the incidence of elevated levels of creatine kinase fo llowing coronary surgery and the characteristics of the patients in compari son with a control group made up of patients who, at a similar time had und ergone a similar angioplasty procedure including, a similar vessel and type of lesion, and equivalent left ventricular function but without elevated s erum levels of creatine kinase. Major adverse coronary events were defined as: cardiac death, nonfatal myocardial infarction, new revascularization an d unstable angina in which hospitalization was required. Results. Out of 309 patients studied, an elevation in creatine kinase was o bserved in 24 patients (7.7%). Complications related to the procedure were found in 50% of these elevations, most of which involved side branch occlus ion. There were no differences with respect to the demographical or anatomi cal characteristics of the lesions in the groups studied. During the follow -up of 9.5 months, complications were observed in 37.5% of the group of pat ients with elevated creatine kinase levels and in 20% of the control group, but this difference did not achieve statistical significance. Conclusions. Creatine kinase elevations are produced in 7.7% of the patient s after coronary angioplasty. Complications related to the procedure were o bserved in 50% of the cases, most being side branch occlusion and no compli cations were seen in the remaining patients. Continuous measurement of crea tine kinase after angioplasty shows a low sensitivity for detecting complic ations during follow-up. New, more sensitive and specific cardiac markers, such as troponin, could define this group of patients.