Death following creatine kinase-MB elevation after coronary intervention - Identification of an early risk period: Importance of creatine kinase-MB level, completeness of revascularization, ventricular function, and probable benefit of statin therapy
Death following creatine kinase-MB elevation after coronary intervention - Identification of an early risk period: Importance of creatine kinase-MB level, completeness of revascularization, ventricular function, and probable benefit of statin therapy
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DOI：
10.1161/01.cir.0000028146.71416.2e
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发表时间：
2002-09-03
期刊：
影响因子：
37.8
通讯作者：
Topol, EJ
中科院分区：
文献类型：
--
作者：
Ellis, SG;Chew, D;Topol, EJ
背景经皮冠状动脉介入治疗 (PCI) 后肌酸激酶 (CK)-MB 升高与随后的心源性死亡相关。处于危险中的患者、危险发生的时间以及潜在的治疗影响均不确定。方法和结果——对8000、409名连续非急性心肌梗死患者进行了成功的PCI且未进行急诊手术或Q波心肌梗塞，随访时间为38-25个月； 1446 名 (17.2%) 的 PCI 后 CK-MB 常规测定高于正常值。患者被前瞻性地分为 CK-MB I 至 5X 或 CK-MB > 5X 正常的患者。 CK-MB 为正常 5 倍的患者在 PCI 后第一周内没有死亡，而 CK-MB 升高的患者早期死亡的过高风险主要发生在前 3 至 4 个月。对于 CK-MB > 5X、CK-MB I 至 5X 以及 CK-MB 小于或等于正常值 1X 的患者，精算 4 个月死亡风险分别为 8.9%、1.9% 和 1.2%（P < 0.001）。 4个月内死亡与CK-MB升高程度、肌酐大于或等于2 mg%、PCI后C反应蛋白、低射血分数、年龄和充血性心力衰竭类别独立相关（均P < 0.01）。在匹配的亚组分析中，不完全血运重建（P < 0.001）、充血性心力衰竭类别（P = 0.005）和出院时未接受他汀类药物治疗（P = 0.009）与死亡相关。 结论：PCI 后 CK-MB 升高的患者死亡风险较高 3 至 4 个月，尽管将 CK-MB 住院时间延长 1 至 5 倍不太可能改变风险。 CK-MB > 5X 正常、血运重建不完全、C 反应蛋白升高、心力衰竭、老年人和出院但未接受他汀类药物治疗会增加风险。其中一些因素表明炎症可能是导致死亡风险过高的原因之一。
Background-Creatine kinase (CK)-MB elevation after percutaneous coronary intervention (PCI) has been associated with subsequent cardiac death. The patients at risk, the timing of risk, and potential treatment implications are uncertain.Methods and Results-Eight thousand, four hundred nine consecutive non-acute myocardial infarction patients with successful PCI and no emergency surgery or Q-wave myocardial infarction were followed for 38 25 months; 1446 (17.2%) had post-PCI CK-MB above normal on routine ascertainment. Patients were prospectively stratified into those with CK-MB I to 5X or CK-MB > 5X normal. No patient with CK-MB I to 5 X normal died during the first week after PCI, and excess risk of early death for patients with CK-MB elevation occurred primarily in the first 3 to 4 months. The actuarial 4-month risk of death was 8.9%, 1.9%, and 1.2% for patients with CK-MB > 5X, CK-MB I to 5X, and CK-MB less than or equal to 1X normal (P < 0.001). Death within 4 months was independently correlated with the degree of CK-MB elevation, creatinine greater than or equal to 2 mg%, post-PCI C-reactive protein, low ejection fraction, age, and congestive heart failure class (P < 0.01 for all). In a matched subset analysis, incomplete revascularization (P < 0.001), congestive heart failure class (P = 0.005), and no statin treatment at hospital discharge (P = 0.009) were associated with death.Conclusions-Patients with CK-MB elevation after PCI are at excess risk of death for 3 to 4 months, although prolonging hospitalization for CK-MB 1 to 5X is unlikely to modify risk. CK-MB > 5X normal, incomplete revascularization, elevated C-reactive protein, heart failure, the elderly, and hospital discharge without on statin therapy increases risk. Several of these factors suggest that inflammation may play a part in the excess risk of death.