TY - JOUR
T1 - Incidence, correlates, and significance of abnormal cardiac enzyme rises in patients treated with surgical or percutaneous based revascularisation
T2 - A substudy from the Synergy between Percutaneous Coronary Interventions with Taxus and Cardiac Surgery (SYNTAX) Trial
AU - Farooq, Vasim
AU - Serruys, Patrick W.
AU - Vranckx, Pascal
AU - Bourantas, Christos V.
AU - Girasis, Chrysafios
AU - Holmes, David R.
AU - Kappetein, Arie Pieter
AU - Mack, Michael
AU - Feldman, Ted
AU - Morice, Marie Claude
AU - Colombo, Antonio
AU - Morel, Marie Angèle
AU - De Vries, Ton
AU - Dawkins, Keith D.
AU - Mohr, Friedrich W.
AU - James, Stefan
AU - Ståhle, Elisabeth
N1 - Funding Information:
Funding: The SYNTAX Trial was funded by the Boston Scientific Corporation .
Funding Information:
Author disclosures: KD Dawkins is all full-time employee in Boston Scientific and holds stock in Boston Scientific. M Mack has served on the Speaker's Bureau of Boston Scientific, Cordis and Medtronic. T Feldman reported serving on the Speaker's Bureau of Boston Scientific, receiving grant support from Abbott, Atritech, BSC, Edwards, and Evalve, and consulting for Abbott, Coherex, Intervalve, Square One, and WL Gore. M Morice reported that her institution received a research grant from Boston Scientific. The other authors report no conflicts of interest.
PY - 2013/10/15
Y1 - 2013/10/15
N2 - Aims The aim of the present investigation was to determine the long-term prognostic association of post-procedural cardiac enzyme elevation within the randomised Synergy between Percutaneous Coronary Intervention (PCI) with TAXUS and Cardiac Surgery (SYNTAX) Trial. Methods 1800 patients with unprotected left main or de novo three-vessel coronary artery disease were randomised to undergo coronary artery bypass graft (CABG) surgery or PCI. Per protocol patients underwent post-procedural blood sampling with creatine kinase (CK), and the cardiac specific MB iso-enzyme (CK-MB) only if the preceding CK ratio was ≥ 2 × the upper limit of normal (ULN). An independent chemistry laboratory evaluated all collected blood samples. Results Post-procedural CK sampling was available in 1629 of 1800 patients (90.5%). As per protocol, CK-MB analyses were undertaken in 474 of 491 patients (96.5%) in the CABG arm, and 53 of 61 patients (86.9%) in the PCI arm. Within the CABG arm, despite the limitations of incomplete data, a post-procedural CK-MB ratio < 3/≥ 3 ULN separated 4-year mortality into low- and high-risk groups (2.3% vs. 9.5%, p = 0.03). Additionally, in the CABG arm, a post-procedural CK-MB ratio ≥ 3 ULN was associated with an increased frequency of a high SYNTAX Score (≥ 33) tertile (high [≥ 33] SYNTAX Score: 39.5%, intermediate [23-32] SYNTAX Score 31.0%, low [≤ 22] SYNTAX Score 29.5%, p = 0.02). Within the PCI arm, a post-procedural CK ratio of < 2 or ≥ 2 ULN separated 4-year mortality into low- and high-risk groups (10.8% vs. 23.3%, p = 0.001). Notably, there was an early (within 6 months) and late (after 2 years) peak in mortality in patients with a post-PCI CK ratio of ≥ 2 ULN. Lack of pre-procedural thienopyridine, carotid artery disease, type 1 diabetes, and presence of coronary bifurcations were independent correlates of a CK ratio ≥ 2 ULN post-PCI. Conclusion Cardiac enzyme elevations post-CABG or post-PCI are associated with an adverse long-term mortality; the causes of which are multifactorial.
AB - Aims The aim of the present investigation was to determine the long-term prognostic association of post-procedural cardiac enzyme elevation within the randomised Synergy between Percutaneous Coronary Intervention (PCI) with TAXUS and Cardiac Surgery (SYNTAX) Trial. Methods 1800 patients with unprotected left main or de novo three-vessel coronary artery disease were randomised to undergo coronary artery bypass graft (CABG) surgery or PCI. Per protocol patients underwent post-procedural blood sampling with creatine kinase (CK), and the cardiac specific MB iso-enzyme (CK-MB) only if the preceding CK ratio was ≥ 2 × the upper limit of normal (ULN). An independent chemistry laboratory evaluated all collected blood samples. Results Post-procedural CK sampling was available in 1629 of 1800 patients (90.5%). As per protocol, CK-MB analyses were undertaken in 474 of 491 patients (96.5%) in the CABG arm, and 53 of 61 patients (86.9%) in the PCI arm. Within the CABG arm, despite the limitations of incomplete data, a post-procedural CK-MB ratio < 3/≥ 3 ULN separated 4-year mortality into low- and high-risk groups (2.3% vs. 9.5%, p = 0.03). Additionally, in the CABG arm, a post-procedural CK-MB ratio ≥ 3 ULN was associated with an increased frequency of a high SYNTAX Score (≥ 33) tertile (high [≥ 33] SYNTAX Score: 39.5%, intermediate [23-32] SYNTAX Score 31.0%, low [≤ 22] SYNTAX Score 29.5%, p = 0.02). Within the PCI arm, a post-procedural CK ratio of < 2 or ≥ 2 ULN separated 4-year mortality into low- and high-risk groups (10.8% vs. 23.3%, p = 0.001). Notably, there was an early (within 6 months) and late (after 2 years) peak in mortality in patients with a post-PCI CK ratio of ≥ 2 ULN. Lack of pre-procedural thienopyridine, carotid artery disease, type 1 diabetes, and presence of coronary bifurcations were independent correlates of a CK ratio ≥ 2 ULN post-PCI. Conclusion Cardiac enzyme elevations post-CABG or post-PCI are associated with an adverse long-term mortality; the causes of which are multifactorial.
KW - Biomarkers
KW - CABG
KW - Mortality
KW - PCI
KW - SYNTAX
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U2 - 10.1016/j.ijcard.2013.08.013
DO - 10.1016/j.ijcard.2013.08.013
M3 - Article
C2 - 23993326
AN - SCOPUS:84887187642
SN - 0167-5273
VL - 168
SP - 5287
EP - 5292
JO - International Journal of Cardiology
JF - International Journal of Cardiology
IS - 6
ER -