Clinical InvestigationsInterventional CardiologyPrognostic importance of creatine kinase and creatine kinase–MB after primary percutaneous coronary intervention for ST-elevation myocardial infarction
Section snippets
Population
From January 1991 to December 2004, individual patient data from all patients with admission diagnosis of STEMI admitted for primary PCI at the Isala klinieken (Zwolle, Netherlands) were prospectively recorded. Patients who died during the first 2 days were not included in this substudy because many of these patients died before peak CK was recorded. Furthermore, patients with peak CK values >10 000 U/L were excluded because these high elevations of CK were probably at least partly due to
Baseline characteristics
Of the 4670 included patients, mean age was 60.8 years (SD 11.8) and 1102 patients (24%) were female. Data on peak CK and peak CK-MB were available in all patients. Mean peak CK was 2327 U/L (SD 2008) and mean CK-MB, 244 (SD 208). The range in the 3 tertiles was <1080 U/L, 1080 to 2660 U/L, and >2660 U/L, respectively, for CK; and <120 U/L, 120 to 281 U/L, and >281 U/L, respectively, for CK-MB. Differences of the baseline characteristics between the tertiles of CK are summarized in Table I and
Discussion
The present study shows that both peak CK and peak CK-MB are comparable independent predictors of LVEF and 1-year mortality in patients after primary PCI for STEMI. Furthermore, particularly patients in the highest tertiles of either CK or CK-MB had a poor prognosis, whereas the differences between the lower tertiles were less clear.
Conclusions
Our study shows an independent association between either peak CK or CK -MB and both LV function and mortality in patients undergoing primary PCI. Accordingly, the worldwide use of these 2 biomarkers seems to be justified, also in patients with TIMI-3 flow after mechanical reperfusion therapy. Future efforts should be aimed toward how to improve treatment in high-risk patients, as identified by peak CK(-MB).
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Cardiac Immunomodulation
2017, The Heart in Rheumatic, Autoimmune and Inflammatory Diseases: Pathophysiology, Clinical Aspects and Therapeutic ApproachesRandomized Control of Sympathetic Drive With Continuous Intravenous Esmolol in Patients With Acute ST-Segment Elevation Myocardial Infarction: The BEtA-Blocker Therapy in Acute Myocardial Infarction (BEAT-AMI) Trial
2016, JACC: Cardiovascular InterventionsCitation Excerpt :Biomarker evaluation is a limitation of the study due to indirect estimation of myocardial damage. On the other hand, all the evaluated biomarkers—troponin (37–41), CK (42,43), CKMB (38,44), and NT-proBNP (45–48)—have been identified as strong prognostic indicators in patients with AMI. In the BEAT-AMI trial, all four evaluated biomarkers were significantly lowered by esmolol-induced heart rate control, indicating a protective effect of acute intravenous esmolol.
Renal dysfunction and hsCRP predict long-term outcomes of percutaneous coronary intervention in acute myocardial infarction
2015, American Journal of the Medical SciencesCitation Excerpt :The authors also analyzed serum biomarkers frequently assessed in clinical practice, such as CTnI, CK and CK-MB. These have been shown to reliably predict infarct size and prognosis in patients with MI.34 Nienhuis et al34 showed that both peak CK and peak CK-MB levels could independently predict mortality and LVEF at 1 year in patients with STEMI who had undergone primary PCI.
Effects of Prolastin C (plasma-derived alpha-1 antitrypsin) on the acute inflammatory response in patients with ST-segment elevation myocardial infarction (from the VCU-alpha 1-RT pilot study)
2015, American Journal of CardiologyCitation Excerpt :There were no clinically significant changes in blood pressure, heart rate, and temperature during infusions (Table 2). Peak creatine kinase-MB, an estimate of infarct size,7 was remarkably similar between patients treated with AAT (123 [48 to 183] ng/ml) and historical placebo controls (123 [77 to 189] ng/ml, p = 0.85). The use of guideline-recommended treatments at discharge was not different comparing Prolastin C versus placebo controls (Supplementary Table 2).
Prognostic implications of creatine kinase-MB measurements in ST-segment elevation myocardial infarction patients treated with primary percutaneous coronary intervention
2014, American Heart JournalCitation Excerpt :In an analysis of the Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications trial, peak CK concentration after primary PCI was shown to be a powerful predictor of 1-year mortality independent of other clinical and angiographic measures.13 In a large prospective cohort study of 4,670 patients from a single center, Nienhuis et al14 demonstrated that peak CK and CK-MB measurements were independent predictors of left ventricular function and 1-year mortality in primary PCI–treated acute MI. Our study of a multicenter primary PCI–treated STEMI cohort with systematically collected core laboratory–determined CK-MB measurements further extends these findings by quantifying the strength of this association.