Incidence and Outcomes of Patients with Peri-Procedural Creatine Kinase (CK-MB) Elevation
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Aims: Peri-procedural myocardial infarction (MI) is not an uncommon complication of percutaneous coronary intervention (PCI). We investigated the incidence and clinical outcomes of patients with peri-procedural creatine kinase elevation over one year followup.
Methods: We prospectively evaluated the consecutive patients undergoing PCI either with acute coronary syndrome (ACS) or chronic stable angina (CSA) as presentation in our unit from July 2014 to December 2015. The term enzymatic infarct (EI) is used to include all patients with peri-procedural CK-MB elevation more than upper limit of normal (ULN). These patients are divided into three categories based on level of enzyme elevation and type of presentation. Type A includes those with CK-MB between 1 to 3 times the ULN, type B includes true peri-procedural MI that means CK-MB >3 times ULN, type C includes patients with baseline CK-MB elevation due to acute MI. We used the PMI definition from the third universal definition of MI: creatine kinase (CK-MB)>3 times upper limit of normal. We followed them up to one year for the major adverse cardiovascular events (MACES) and other complications. We compared the mortality rate between peri-procedural enzymatic infarct group and non peri-procedural enzymatic infarct patients along with incidence of peri-procedural EI in CSA versus ACS subgroups and tested for the significance.
Results: Out of total 748 patients who undergone PCI in our unit, the total incidence of peri-procedural EI was 7.7%. Among total 58 peri-procedural EI events, 23(3%) were in patients with ACS presentation (p=0.001) and 34(4.5%) were in patients with CSA presentation (p=0.0001). Patients with peri-procedural EI had significantly higher risk of mortality than those without peri-procedural EI (5.1% versus 0.2%, p= 0.001). In subgroup analysis among patients with peri-procedural EI the mortality is higher in patients with ACS presentation compared to those with CSA as presentation (8.6% versus 2.9%(p=0.01)), and the total mortality is confined to the type B enzymatic infarct group.
Conclusion: Among patients undergoing PCI, the occurrence of peri-procedural EI measured by CK-MB mass assay was 7.7% and Peri-procedural EI type B was associated with significant increase in mortality over one year followup.