Periprocedural creatine kinase‐mb elevations: Long‐term impact and clinical implications

Abstract

Since the introduction of percutaneous transluminal coronary angioplasty (PTCA), percutaneous intervention with balloon catheters, stents, and atherectomy devices has become a widely accepted practice. The persistent complication of non-Q-wave myocardial infarction (MI), as evidenced by increased cardiac enzyme levels after intervention, has aroused only moderate concern because its incidence was perceived to be small and not clinically relevant. With more systematic assessments of cardiac enzymes--specifically, creatine kinase (CK) and its MB isoform--evidence has begun to clarify both the incidence and the prognosis of periprocedural non-Q-wave MI: It appears to occur nearly three times more often than is clinically evident across all device types (8 to 9% of all interventions) and is directly and continuously associated with adverse outcomes, including late death. Although directional and rotational atherectomy improve angiographic outcome compared with PTCA, periprocedural infarction occurs at least twice as often with these newer technologies; the incidence associated with stent placement is comparable to and possibly higher than that of PTCA. Factors that may cause elevated CK-MB levels include distal embolization, side branch occlusion, thrombus, and coronary spasm. Analyses of the major trials of platelet glycoprotein (GP) IIb/IIIa receptor inhibitors, a class of potent antiplatelet agents, show striking effectiveness of these drugs in reducing the incidence of "enzyme-only" or "silent" MI and in improving long-term clinical outcomes. The findings implicate platelet mediation in the occurrence of periprocedural infarction and suggest an important role for antiplatelet therapy, particularly GP IIb/IIIa receptor inhibition, in protecting patients undergoing percutaneous intervention.

Serum Creatine Kinase-MB Isoenzyme Activity among Subjects with Uncomplicated Essential Hypertension: Any Sex Differences

“…However, long-term mortality in those patients was observed to be similar to patients without CK-MB elevation in another study [ 68 ]. In studies involving patients with coronary intervention, CK-MB activity was elevated in 10–40% of the patients and was associated with an increased risk of adverse outcomes [ 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 ]. The multivariate regression analysis of CK-MB activity was significantly associated with blood pressure in females after excluding those subjects on antihypertensive medications.…”

The effect of dalteparin versus unfractionated heparin on the levels of troponin I and creatine kinase isoenzyme MB in elective percutaneous coronary intervention

“…Clinically, cTnI and CK-MB are commonly used sensitive and specific markers of myocardial injury. CK-MB, which has high specificity, has served as a classic indicator of myocardial injury in the diagnosis of myocardial injury 12 and also has a good long-term predictive value in patients undergoing PCI 13 , 14 . The sensitivity and specificity of cTnI as a myocardial injury marker are greater than those of CK-MB; in addition, cTnI has a longer diagnostic time window of up to 14 days 15 , 16 .…”