Prognostic significance of elevated creatine kinase MB after coronary bypass surgery and after an acute coronary syndrome: results from the GUARDIAN trial

Abstract

Modest elevations of creatine kinase-myocardial band release (> or =1 and <10 ULN) after coronary artery bypass surgery are not associated with adverse 6-month survival, in contrast to that seen in acute coronary syndrome patients. Routine creatine kinase-myocardial band sampling should be considered in all higher-risk patients undergoing coronary artery bypass surgery procedures to identify the sizable cohort of patients with creatine kinase-myocardial band release > or =10 ULN; these patients may benefit from postoperative angiotensin-converting enzyme inhibitor and beta-blocker therapy. Newer cardioprotective agents that reduce the number of patients with marked creatine kinase-myocardial band release are currently being tested in large randomized controlled clinical trials.

Periprocedural Cardiac Enzyme Elevation Predicts Adverse Outcomes

“…The Guard During Ischemia Against Necrosis (GUARDIAN) study found a strong relationship between CK elevation Ͼ10 times the ULN and 6-month mortality. 48 Although lower degrees of CK elevation were not associated with mortality in that study, with a longer follow-up, a relationship may have emerged. Other studies have found a graded increase in mortality across the full spectrum of CK elevation, including CK-MB Ͼ3 times the ULN.…”

Periprocedural Myocardial Infarction

“…The Guard During Ischemia Against Necrosis (GUARDIAN) study in 2332 CABG patients demonstrated the strongest mortality risk associated with large CK elevations (those above 10ϫ ULN) at 6-month follow-up. 82 Another registry of 3667 CABG patients with 5-year follow-up showed a graded reduction in survival associated with post-CABG CK-MB (CK-MB ϽULN: 80%; CK-MB 1 to 3ϫ ULN: 78%; CK-MB Ͼ3ϫ ULN: 73%; Pϭ0.0008). Every unit increment of CK-MB was independently associated with mortality (odds ratio; 95% CI, 1.04 [1.009 to 1.062]; Pϭ0.0007).…”

Terminal Complement Blockade With Pexelizumab During Coronary Artery Bypass Graft Surgery Requiring Cardiopulmonary Bypass

“…Additionally, at any time during the trial, the primary investigator was able to identify the occurrence of an MI for adjudication by the clinical events committee. Creatine kinase-MB measurements were collected at 4,8,12,16,24,72, and 96 hours postoperatively and were analyzed at a central core laboratory. Electrocardiograms were recorded at patient enrollment as well as at 48 and 96 hours and 14, 30, 90, and 180 days postoperatively.…”