Minimal myocardial damage during coronary intervention is associated with impaired outcome

Simoons, Maarten L.; Brand, Marcel van den; Lincoff, Michael; Harrington, Robert A.; Wieken, Ron van der; Vahanian, Alec; Rutsch, Wolfgang; Kootstra, J; Boersma, Eric; Califf, Robert M.; Topol, Eric J.

doi:10.1053/euhj.1999.1521

Cited by 95 publications

(55 citation statements)

References 16 publications

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“…3,4,6 The protocols and results of the studies have been published. 3,4,6 In brief, CAPTURE, EPIC, and EPILOG were large, randomized trials evaluating the glycoprotein IIb/IIIa inhibitor abciximab in patients undergoing PCI for a variety of indications. 4 The IMPACT-II trial evaluated eptifibatide in patients scheduled for elective, urgent, or emergency PCI.…”

Section: Prognostic Significance Of Ck-mb Elevation After Pcimentioning

confidence: 99%

“…3,4,6 In brief, CAPTURE, EPIC, and EPILOG were large, randomized trials evaluating the glycoprotein IIb/IIIa inhibitor abciximab in patients undergoing PCI for a variety of indications. 4 The IMPACT-II trial evaluated eptifibatide in patients scheduled for elective, urgent, or emergency PCI. 3 A similar analysis was done in the subgroup of PURSUIT patients who underwent PCI in the first 30 days after randomization and had at least one CK-MB sample collected in the first 48 hours after the intervention.…”

Section: Prognostic Significance Of Ck-mb Elevation After Pcimentioning

confidence: 99%

“…It is conceivable that microinfarcts provide a nidus for ventricular arrhythmias via a microreentry or a focal mechanism. 1,2,4,5 Indeed, previous studies have demonstrated the association between small PCI-related infarcts and subsequent sudden death. 1,4 Furthermore, myocardial necrosis occurring during the procedure may be an expression of vascular instability.…”

Section: Mortality At 6-month Follow-up Stratified By Peak Ck-mb Levelmentioning

confidence: 99%

“…[1][2][3][4] Multiple studies have shown a proportional relationship between the level of postprocedural CK-MB elevation and the risk of adverse outcome during follow-up, even in patients with an otherwise apparently uncomplicated and successful intervention and after adjustment for other prognostic factors [2][3][4][5] ; however, the clinical significance of asymptomatic PCI-related cardiac enzyme elevation remains controversial. In contrast, the prognostic significance of (small) myocardial infarctions (MI) occurring spontaneously in the setting of unstable angina or after acute MI has been well established.…”

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Minor Myocardial Damage and Prognosis

et al. 2002

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Background-The relevance of the adverse prognostic implications of CK-MB elevation after percutaneous coronary intervention (PCI) remains controversial. Therefore, we compared the relationship between the level of postprocedural CK-MB elevation and 6-month mortality in patients undergoing PCI with the relationship between the level of spontaneous, non-PCI-related CK-MB elevation and 6-month mortality in patients with acute coronary syndromes (ACS) treated medically. Methods and Results-In the PURSUIT trial, 5583 of 9461 patients who presented with a non-ST-elevation ACS did not undergo PCI or CABG and had at least 1 CK-MB sample collected during index-hospitalization. There was a gradual increase in 6-month mortality with higher CK-MB levels: 4.1%, 8.6%, 9.0%, 14.3%, 15.5% for CK-MB ratios 0 to 1, Ͼ1 to 3, Ͼ3 to 5, Ͼ5 to 10, and Ͼ10 times the upper limit of normal. A combined analysis in 8838 patients undergoing PCI in 5 large, clinical trials revealed a proportional relationship between postprocedural CK-MB levels (Յ48 hours after PCI) and 6-month mortality. In patients with CK-MB ratios 0 to 1, Ͼ1 to 3, Ͼ3 to 5, Ͼ5 to 10, and Ͼ10, the risk of death was 1.3%, 2.0%, 2.3%, 4.3%, and 7.4%, respectively. The absolute mortality rates were lower after procedure-related infarcts compared with spontaneous infarcts. Yet, the relative increase in 6-month mortality with each increase in peak CK-MB level was similar for PCI-related myocardial necrosis and spontaneous myocardial necrosis, as all tests for heterogeneity of the odds ratios were nonsignificant. Conclusions-The present analysis indicates that the adverse prognostic implications of periprocedural myocardial necrosis should be considered similar to the adverse consequences of spontaneous myocardial necrosis. (Circulation. 2002;105:554-556.)

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Section: Prognostic Significance Of Ck-mb Elevation After Pcimentioning

confidence: 99%

Section: Prognostic Significance Of Ck-mb Elevation After Pcimentioning

confidence: 99%

Section: Mortality At 6-month Follow-up Stratified By Peak Ck-mb Levelmentioning

confidence: 99%

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confidence: 99%

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Minor Myocardial Damage and Prognosis

et al. 2002

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“…[1][2][3][4] Elevation of CK-MB following percutaneous coronary revascularization procedures has been demonstrated to occur in 6% to 34% of patients. [5][6][7][8][9][10] A recent consensus report has proposed a CK-MB threshold of 3 times the upper limit of normal for percutaneous revascularization and 5 times for bypass surgery as a marker for periprocedural myocardial infarction and subsequent increased risk of adverse events. 1 This recommendation is derived mainly from reports on the prognostic significance of cardiac enzyme elevation after balloon angioplasty or directional coronary atherectomy (DCA).…”

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confidence: 99%

Incidence, Predictors, and Significance of Abnormal Cardiac Enzyme Rise in Patients Treated With Bypass Surgery in the Arterial Revascularization Therapies Study (ARTS)

2001

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on behalf of ARTS study group Background-Although it has been suggested that elevation of CK-MB after percutaneous coronary intervention is associated with adverse clinical outcomes, limited data are available in the setting of coronary bypass grafting. The 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 Therapies Study (ARTS). CK-MB was prospectively measured at 6, 12, and 18 hours after 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 death and repeat myocardial infarction within the first 30 days (Pϭ0.001). CK-MB elevation was also independently related to late adverse outcome (Pϭ0.009, ORϭ0.64). Conclusions-Increased

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Association Between Minor Elevations of Creatine Kinase-MB Level and Mortality in Patients With Acute Coronary Syndromes Without ST-Segment Elevation

Alexander¹

2000

JAMA

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Minimal myocardial damage during coronary intervention is associated with impaired outcome

Abstract: Modest elevation of cardiac enzymes (creatine kinase-MB, creatine kinase) after percutaneous coronary intervention is associated with an increased risk of mortality and reinfarction during the 6 month follow-up. Measures to reduce such periprocedural infarcts are warranted.

Cited by 95 publications

References 16 publications

Minor Myocardial Damage and Prognosis

Minor Myocardial Damage and Prognosis

Incidence, Predictors, and Significance of Abnormal Cardiac Enzyme Rise in Patients Treated With Bypass Surgery in the Arterial Revascularization Therapies Study (ARTS)

Association Between Minor Elevations of Creatine Kinase-MB Level and Mortality in Patients With Acute Coronary Syndromes Without ST-Segment Elevation

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