Prognostic Implications of Creatine Kinase Elevation After Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction

Prognostic Implications of Creatine Kinase Elevation After Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction Amir Halkin, Gregg W. Stone, Cindy L. Grines, David A. Cox, Barry D. Rutherford, Paolo Esente, Carol M. Meils, Per Albertsson, Anthony Farah, James E. Tcheng, Alexandra J. Lansky, Roxana Mehran In the Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) trial, 1,529 acute myocardial infarction patients undergoing primary angioplasty had creatine kinase (CK) levels determined at baseline and at 8 ± 1 h, 16 ± 1 h, and 24 ± 1 h after percutaneous coronary intervention. The CK levels at all post-procedural time points were significantly higher in patients who died compared with the one-year survivors, as was CKpeak(mean, 2,865 U/l vs. 1,885 U/l, respectively, p ≤ 0.001). The CKpeakwas a significant multivariate predictor of one-year mortality (hazard ratio = 2.15, p = 0.0002). The left ventricular ejection fraction and its improvement from baseline at the seven-month level were inversely correlated with CKpeak(p < 0.001 for both). In contrast, the time to CKpeakwas not independently predictive of mortality or myocardial recovery. We examined the prognostic implications of the absolute level and rate of increase of creatine kinase (CK) elevation after primary percutaneous coronary intervention (PCI). Peak creatine kinase (CKpeak) and the rate of CK increase are related to reperfusion success and clinical outcomes after thrombolytic therapy for acute myocardial infarction (AMI). The utility of routine serial CK monitoring after primary PCI, in which normal antegrade blood flow is restored in most patients, is unknown. In the Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) trial, 1,529 patients with AMI randomized to either stenting or balloon angioplasty, each with or without abciximab, had CK levels determined at baseline and at 8 ± 1 h, 16 ± 1 h, and 24 ± 1 h after PCI. The CKpeakoccurred at baseline in 3.9% of patients, at 8 ± 1 h in 69.6%, at 16 ± 1 h in 20.0%, and at 24 ± 1 h in 6.5%. The CK levels at all post-procedural time points were significantly higher in patients who died compared with the one-year survivors, as was CKpeak(mean, 2,865 U/l vs. 1,885 U/l, respectively, p ≤ 0.001). By multivariate analysis, CKpeakwas a significant predictor of one-year mortality (hazard ratio = 2.15, p = 0.0002), independent from post-PCI Thrombol