Incidence, predictors, and significance of abnormal cardiac enzyme rise inpatients treated with bypass surgery in the Arterial Revascularization Therapies Study (ARTS)

Background-Although it has been suggested that elevation of CK-MB after per cutaneous coronary intervention is associated with adverse clinical outcome s, limited data are available in the setting of coronary bypass grafting. T he aim of the present study was to determine the incidence, predictors, and prognostic significance of CK-MB elevation following multivessel coronary bypass grafting (CABG). Methods and Results-The population comprises 496 patients with multivessel coronary disease assigned to CABG in the Arterial Revascularization Therapi es Study (ARTS). CK-MB was prospectively measured at 6, 12, and 18 hours af ter the procedure. Thirty-day and 1-year clinical follow-up were performed. Abnormal CK-MB elevation occurred in 61.9% of the patients. Patients with increased cardiac-enzyme levels after CABG were at increased risk of both d eath and repeat myocardial infarction within the first 30 days (P=0.001). C K-MB elevation was also independently related to late adverse outcome (P=0. 009, OR=0.64). Conclusions-Increased concentrations of CK-MB, which are often dismissed as inconsequential in the setting of multivessel CABG, appear to occur very f requently and are associated with a significant increase in both repeat myo cardial infarction and death beyond the immediate perioperative period.