Creatine kinase-MB fraction elevation after percutaneous coronary intervention in patients with chronic renal failure

We evaluated the short- and long-term clinical outcomes of 326 consecutive patients with chronic renal failure, not on dialysis, who had creatine kina se (CK)-myocardial band (MB) fraction elevation after successful percutaneo us coronary intervention in a native coronary artery. Based on peak CK-MB l evels measured after intervention, patients were divided into 3 groups: no elevation (group 1, n = 184), 1 to 3 x upper normal levels (group 2, n = 72 ), and > 3 x upper normal levels (group 3, n = 70). Baseline clinical and a ngiographic characteristics were similar among the 3 groups. Angiographic s uccess was similar among the 3 groups, although there was a significantly h igher use of intra-aortic balloon pump in patients who had postprocedural C K-MB >3 x normal values and a higher rate of in-hospital complications, i.e ., repeat catheterization, repeat target lesion intervention, pulmonary ede ma, renal function deterioration, emergency dialysis, and major bleeding co mplications. At I-year follow-up, mortality rates were significantly higher in these patients (35.4% vs 22.0% for patients with CK-MB 1 to 3 x normal values and 16.7% for patients without CK-MB elevation, p = 0.007). Multivar iate analysis showed that CK-MB >3 x normal (odds ratio 3.04; 95% confidenc e interval 1.41 to 6.57, p = 0.005) and intra-aortic balloon pump (odds rat io 1.49; confidence interval 1.15 to 1.93, p = 0.002) were independent pred ictors of late mortality. Therefore, patients with chronic renal failure wh o had CK-MB elevation > 3 x the upper normal limit after a successful percu taneous coronary intervention had a higher incidence of in-hospital complic ations and a significantly higher mortality rate at 1-year follow-vp than p atients without CK-MB elevation or with <3 x normal CK-MB elevation. (C) 20 01 by Excerpta Medica, Inc.