Creatine Kinase-MB Enzyme Elevation Following Successful Saphenous Vein Graft Intervention Is Associated With Late Mortality

Hong, Mun K.; Mehran, Roxana; Dangas, George; Mintz, Gary S.; Lansky, Alexandra J.; Pichard, Augusto D.; Kent, Kenneth M.; Satler, Lowell F.; Stone, Gregg W.; Leon, Martin B.

doi:10.1161/01.cir.100.24.2400

Cited by 218 publications

(118 citation statements)

References 10 publications

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“…Indeed, periprocedural subendocardial MI, defined by the most commonly accepted criteria (CPK-MB Ͼ3ϫ ULN without new Q waves), occurred in 18% of patients. The high incidence of periprocedural MI may be explained by the tertiary referral nature of the patient population (in whom vein graft intervention was frequent, 14 diffuse atherosclerosis was evident, 15 and multiple lesion intervention was common) as well as the routine systematic collection and analysis of serial CPK-MB samples by a sensitive radioimmunoassay. Given the high incidence of myonecrosis after percutaneous intervention, it is essential to identify in which patients the prognosis is adversely affected.…”

Section: Incidence and Impact Of MI After Percutaneous Interventionmentioning

confidence: 99%

Differential Impact on Survival of Electrocardiographic Q-Wave Versus Enzymatic Myocardial Infarction After Percutaneous Intervention

et al. 2001

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Background-The relative prognostic importance of ECG myocardial infarction (MI) after intervention compared with varying degrees of enzymatic elevation has not been characterized, and the device-specific implications of periprocedural MI are also unknown. Methods and Results-Serial creatine phosphokinase (CPK)-MB levels were determined after elective percutaneous intervention of 12 098 lesions in 7147 consecutive patients at a tertiary referral center. Procedural, in-hospital, and follow-up data were collected by independent research nurses, and clinical and ECG events were adjudicated by a separate committee. Stents were implanted in 50.6% of lesions, atheroablation was performed in 54.8%, and PTCA alone was performed in 9.8%. The peak periprocedural CPK-MB level was Ͼ3ϫ the upper limit of normal (ULN) in 17.9% of patients, and Q-wave MI developed in 0.6%. By multivariate analysis, the periprocedural development of new Q waves was the most powerful independent determinant of death (2-year mortality rate, 38.3%; hazard ratio, 9.9; PϽ0.0001). Non-Q-wave MI with CPK-MB Ͼ8ϫ ULN was also a strong predictor of death (2-year mortality rate, 16.3%; hazard ratio, 2.2; PϽ0.0001); survival was unaffected by lesser degrees of CPK-MB elevation. Though CPK-MB elevation was more common after atheroablation and stenting than PTCA, the rates of Q-wave MI and survival were device-independent. Conclusions-Myonecrosis

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Section: Incidence and Impact Of MI After Percutaneous Interventionmentioning

confidence: 99%

Differential Impact on Survival of Electrocardiographic Q-Wave Versus Enzymatic Myocardial Infarction After Percutaneous Intervention

et al. 2001

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“…The lower intraprocedural use of glycoprotein IIb/IIIa inhibitors in high-risk patients may be explained by the higher prevalence of older patients, who have an increased risk of vascular and nonvascular bleeding, and higher rates of saphenous vein graft and in-stent restenosis, where the use of these agents has been controversial (7,25). Periprocedural creatine kinase-MB elevation three times the normal occurs in 4% to 5% of patients and use of glycoprotein IIb/IIIa inhibitors has been shown to decrease enzyme release (6,7,17).…”

Section: Discussionmentioning

confidence: 99%

“…Periprocedural creatine kinase-MB elevation three times the normal occurs in 4% to 5% of patients and use of glycoprotein IIb/IIIa inhibitors has been shown to decrease enzyme release (6,7,17). Both creatine kinase-MB and troponin I elevation were higher in our high-risk group, perhaps due to increased distal thromboembolism, which can be further reduced by aggressive antiplatelet therapy and use of distal protection devices (25)(26)(27).…”

Section: Discussionmentioning

confidence: 99%

Prediction of outcome after percutaneous coronary intervention for the acute coronary syndrome

Kini

Lee

Mitre

et al. 2003

The American Journal of Medicine

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BACKGROUND:The seven-component Thrombolysis In Myocardial Infarction (TIMI) score has been used to risk stratify, and to guide the medical management of, patients with unstable angina or non-ST-elevation myocardial infarction. We assessed the usefulness of the risk score in predicting in-hospital and 30-day outcomes in such patients who were undergoing percutaneous coronary intervention. METHODS: Using the TIMI score, 2501 patients with unstable angina or non-ST-elevation myocardial infarction were divided into low-risk (zero to two risk factors; n ϭ 974), intermediaterisk (three to four risk factors; n ϭ 1339), and high-risk (five to seven risk factors; n ϭ 188) groups, and outcomes were compared. RESULTS: Angiographic/clinical success and the rate of minor procedural events were similar among the three groups. A higher TIMI risk score was associated with more cardiac comorbid conditions and more complicated angiographic lesions: longer lesions (P ϭ 0.0009), more thrombotic lesions (P ϭ

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“…Furthermore, compared with PCI of native coronary arteries, PCI of grafted vessels, especially saphenous vein grafts, was associated with worse clinical outcomes, mainly because of distal embolization during PCI and target vessel revascularization. 24 The limited efficacy of PCI demonstrated by these findings highlights that redo CABG surgery with multiple arterial grafting is a therapeutic option for secondary revascularization, even when considering operative risks. 4,18,19 We performed this analysis to examine the prognostic benefit of the post-PCI CSS compared with the bCSS, as shown in Table 4.…”

Section: Limited Efficacy Of Pci and The Importance Of Secondary Prevmentioning

confidence: 97%

Validation of the Coronary Artery Bypass Graft SYNTAX Score (Synergy Between Percutaneous Coronary Intervention With Taxus) as a Prognostic Marker for Patients With Previous Coronary Artery Bypass Graft Surgery After Percutaneous Coronary Intervention

Miyagi

Asaumi

Nishimura

et al. 2016

Circ: Cardiovascular Interventions

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C oronary artery bypass graft (CABG) surgery has been the standard of care for coronary revascularization. However, during long-term follow-up after initial CABG surgery, patients are at risk of subsequent ischemia because of late graft failures and degeneration of native coronary arteries.2 Regarding repeat coronary revascularization in previous CABG surgery cases, in particular for late failure of saphenous vein grafts, the number of patients referred for percutaneous coronary intervention (PCI) has been increasing. 2,3However, in patients with previous CABG surgery, the optimal revascularization strategy and risk stratification are not yet fully known. 4,5Background-The efficacy and prognosis of percutaneous coronary intervention (PCI) as secondary revascularization in patients with previous coronary artery bypass graft surgery remain uncertain. Methods and Results-We retrospectively evaluated 434 consecutive patients with previous coronary artery bypass graft surgery hospitalized for PCI between 2004 and 2011 (men 84%, age 71 (interquartile range, 66-76) years) and calculated the coronary artery bypass graft Synergy Between Percutaneous Coronary Intervention With Taxus score (CSS) before (baseline CSS) and after PCI (post-PCI CSS). Patients were divided into 2 groups based on median post-PCI CSS: low-score (≤23; n=217) and high-score groups (>23; n=217). Major adverse cardiovascular events (MACE) were defined as the composite of cardiovascular death, myocardial infarction, and unplanned repeat revascularization for myocardial ischemia. The median baseline and post-PCI CSS were 30 (interquartile range, 21-40) and 23 (interquartile range, 14.5-33.5), respectively. During a median follow-up of 69 months, the prevalence of MACE and cardiac death differed significantly between the 2 post-PCI CSS groups (MACE: low, 13.8%; high, 28.6%; P<0.001; cardiac death: low, 6.2%; high, 16.7%; P=0.002). In multivariable analysis, the high post-PCI CSS divided by the median was associated with substantially greater cumulative MACE (hazard ratio, 2.09; 95% confidence interval, 1.31-3.34; P=0.002) and cardiac death (hazard ratio, 2.02; 95% confidence interval, 1.03-3.98; P=0.042) compared with the low post-PCI CSS. Net reclassification improvement analysis revealed that post-PCI CSS resulted in significantly improved prediction of MACE and cardiac death compared with baseline CSS. Conclusions-In this external validation study, the CSS was a potential prognostic factor after subsequent PCI, even for previous coronary artery bypass graft surgery patients. (Circ Cardiovasc Interv. 2016;9:e003459.

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Creatine Kinase-MB Enzyme Elevation Following Successful Saphenous Vein Graft Intervention Is Associated With Late Mortality

Abstract: Major CK-MB elevation occurs after 15% of otherwise successful SVG interventions and is associated with increased late mortality.

Cited by 218 publications

References 10 publications

Differential Impact on Survival of Electrocardiographic Q-Wave Versus Enzymatic Myocardial Infarction After Percutaneous Intervention

Differential Impact on Survival of Electrocardiographic Q-Wave Versus Enzymatic Myocardial Infarction After Percutaneous Intervention

Prediction of outcome after percutaneous coronary intervention for the acute coronary syndrome

Validation of the Coronary Artery Bypass Graft SYNTAX Score (Synergy Between Percutaneous Coronary Intervention With Taxus) as a Prognostic Marker for Patients With Previous Coronary Artery Bypass Graft Surgery After Percutaneous Coronary Intervention

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