Obj
ectiv
es. W
e examin
ed th
e r
elations of
el
evat
ed cr
eatin
e kinas
e (CK) and its myocardial band iso
enzym
e (CK-MB) to clinical outcom
es aft
er p
ercutan
eous coronary int
erv
ention (PCI) in pati
ents
enroll
ed in Int
egrilin (
eptifibatid
e) to Minimiz
e Plat
el
et Aggr
egation and Coronary Thrombosis-II (trial) (IMPACT-II), a trial of th
e plat
el
et glycoprot
ein IIb/IIIa inhibitor
eptifibatid
e.
Background. Elevation of cardiac enzymes often occurs after PCI, but its clinical implications are uncertain.
Methods. Patients undergoing elective, scheduled PCI for any indication were analyzed. Parallel analyses investigated CK (n = 3,535) and CK-MB (n = 2,341) levels after PCI (within 4 to 20 h). Clinical outcomes at 30 days and 6 months were stratified by postprocedure CK and CK-MB (multiple of the site’s upper normal limit).
Results. Overall, 1,779 patients (76 % ) had no CK-MB elevation; CK-MB levels were elevated to 1 to 3 times the upper normal limit in 323 patients (13.8 % ), to 3 to 5 times normal in 84 (3.6 % ), to 5 to 10 times normal in 86 (3.7 % ), and to e;10 times normal in 69 patients (2.9 % ). Elevated CK-MB was associated with an increased risk of death, reinfarction, or emergency revascularization at 30 days, and of death, reinfarction, or surgical revascularization at 6 months. Elevated total CK to above three times normal was less frequent, but its prognostic significance paralleled that seen for CK-MB. The degree of risk correlated with the rise in CK or CK-MB, even for patients with successful procedures not complicated by abrupt closure.
Conclusions. Elevations in cardiac enzymes, including small increases (between one and three times normal) often not considered an infarction, are associated with an increased risk for short-term adverse clinical outcomes after successful or unsuccessful PCI.