Elevated creatine kinase-MB with normal creatine kinase predicts worse outcomes in patients with acute coronary syndromes: Results from 4 large clinical trials - 17/08/11
, Shelly K. Sapp, MS a, John H. Alexander, MD, MHS, FACC a, Matthew T. Roe, MD, MHS, FACC a, E. Magnus Ohman, MD, FACC b, Christopher B. Granger, MD, FACC a, Paul W. Armstrong, MD, FACC c, Robert A. Harrington, MD, FACC a, Harvey D. White, DSc, FACC d, Maarten L. Simoons, MD, FACC e, L. Kristin Newby, MD, MHS, FACC a, Robert M. Califf, MD, FACC a, Eric J. Topol, MD, FACC fRésumé |
Background |
The degree to which elevated creatine kinase (CK)-MB in the presence of normal CK is predictive of outcome is not well understood despite having been studied for decades. This analysis examined whether normal CK with elevated CK-MB in patients with non–ST-segment elevation acute coronary syndrome (NSTE ACS) is an independent predictor of worse outcomes. A concomitant goal was to contribute insight to the debate over how patients with NSTE ACS should be managed.
Methods |
Data for 25960 patients from the GUSTO IIb, PARAGON A and B, and PURSUIT trials were analyzed. Of these patients, 6402 were excluded from primary analysis because of missing (unmeasured) biomarkers. Patients with complete laboratory data (n = 19558) were grouped by CK and CK-MB results. To confirm the primary analysis results, data from patients with missing biomarkers were used in an imputation model.
Results |
Patients were categorized in 1 of 4 groups: normal CK + normal CK-MB; normal CK + elevated CK-MB; elevated CK + normal CK-MB; or elevated CK + elevated CK-MB. For the primary outcome, 180-day death, or myocardial infarction, Kaplan-Meier estimates were 14.9%, 20.8%, 14.5%, and 18.2%, respectively. Regardless of total CK, elevated CK-MB was associated with a 25% to 49% increased relative risk of worse outcomes. Findings from the analyses were verified by the multivariable model.
Conclusions |
CK-MB remains a reliable marker for myocardial necrosis and a strong predictor of worse prognosis. All patients with ACS should have CK-MB measurement to search for cardiac ischemia. Patients with elevated CK-MB should receive aggressive management commensurate with their increased risks.
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Vol 151 - N° 1
P. 16-24 - janvier 2006 Retour au numéro
Article précédent
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- Hussam Al-Faleh, Yuling Fu, Galen Wagner, Shaun Goodman, Elena Sgarbossa, Christopher Granger, Frans Van de Werf, Lars Wallentin, Paul W. Armstrong, for the ASSENT 2 and 3 Investigators
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