Prognostic implications of creatine kinase-MB measurements in ST-segment elevation myocardial infarction patients treated with primary percutaneous coronary intervention

Akshay Bagai, Phillip J. Schulte, Christopher B. Granger, Kenneth W. Mahaffey, Robert H. Christenson, Gregory Bell, Renato D. Lopes, Cynthia L. Green, A. Michael Lincoff, Paul W. Armstrong, Matthew T. Roe

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13 Scopus citations

Abstract

Background Peak creatine kinase (CK)-MB concentration is related to reperfusion success and clinical outcomes after fibrinolytic therapy for acute myocardial infarction. However, prognostic implications of CK-MB measurements after primary percutaneous coronary intervention (PCI), which provides more predictable and consistent reperfusion, are unknown. Methods We pooled 2,042 primary PCI-treated ST-segment elevation myocardial infarction (STEMI) patients from 3 trials with serial core laboratory-determined CK-MB measurements; 1,799 patients (88.1%) who survived to 36 hours and had ≥4 CK-MB measurements were studied. Cox regression modeling was performed to quantify the association between peak CK-MB concentration (and area under the time-concentration curve [AUC]) and mortality at 6 months, and death or congestive heart failure at 90 days. Results The median (25th-75th percentiles) peak CK-MB concentration and AUC measurement through 36 hours were 239 (109-429) ng/mL and 4,263 (2,081-7,124) ng/(mL h), respectively. By multivariable analysis, peak CK-MB concentration and AUC measurement were independently associated with 6-month mortality (adjusted hazard ratio [HR] 1.15, 95% CI 1.05-1.25, per 100-ng/mL increase, P =.002; and adjusted HR 1.09, 95% CI 1.03-1.14, per 1,000-ng/[mL h] increase, P <.001, respectively) and 90-day death or congestive heart failure (adjusted HR 1.26, 95% CI 1.18-1.34, P <.001; and adjusted HR 1.15, 95% CI 1.11-1.19, P <.001, respectively). Conclusions Peak CK-MB concentration and AUC measurement are independent predictors of 3- to 6-month cardiovascular outcomes in primary PCI-treated STEMI patients. Our findings guide application of these measurements as efficacy end points in early-phase studies evaluating new therapies for STEMI.

Original languageEnglish (US)
Pages (from-to)503-511.e2
JournalAmerican Heart Journal
Volume168
Issue number4
DOIs
StatePublished - Oct 1 2014

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Bagai, A., Schulte, P. J., Granger, C. B., Mahaffey, K. W., Christenson, R. H., Bell, G., Lopes, R. D., Green, C. L., Lincoff, A. M., Armstrong, P. W., & Roe, M. T. (2014). Prognostic implications of creatine kinase-MB measurements in ST-segment elevation myocardial infarction patients treated with primary percutaneous coronary intervention. American Heart Journal, 168(4), 503-511.e2. https://doi.org/10.1016/j.ahj.2014.06.008