Prognostic implication of XXXX kinase release after elective percutaneous coronary intervention in the pre-IIb/IIIa antagonist era.

@entity1 @entity908
BACKGROUND: The significance of mild elevations in cardiac enzymes after an elective percutaneous coronary intervention (PCI) still remains controversial. We evaluated the significance of @entity908 phosphokinase level (CPK) elevations in a large cohort of @entity1 who had undergone an elective PCI before the IIb/IIIa receptor antagonist era. METHODS: All @entity1 enrolled in the Emory databank from 1981 to 1996 who had an elective PCI were evaluated. We identified 15,637 @entity1 who met our inclusion and exclusion criteria. @entity1 were divided into 4 groups on the basis of the magnitude of the CPK elevation noted in the post-PCI period: group I (CPK <250 mg/dL, n = 14,512); group II (CPK 250-500 mg/dL, n = 715); group III (CPK 500-750 mg/dL, n = 164); and group IV (CPK >750 mg/dL, n = 246). RESULTS: CPK elevations were associated with a significant increase in the periprocedure angiographic complications. Angiographic complication rates were 14.6%, 30.5%, 40.2%, and 43.5% in groups I, II, III, and IV, respectively (P <.001). Long-term survival also correlated inversely with the magnitude of CPK elevations. The 10-year survival rates were 73%, 71%, 69%, and 55% in groups I, II, III, and IV, respectively (P <.0001). After multivariate analysis to correct for clinical factors, a CPK elevation of at least 3-times normal (group IV) was found to be an independent predictor of diminished 30-day and long-term survival (hazard ratio 1.84, 95% CI 1.41-2.41, P <.0001). Elevations in CPK <3-times normal (groups II and III) were not independently predictive of poor long-term survival. CONCLUSION: A CPK level >3-times normal after an elective PCI is a strong independent predictor of poor long-term prognosis.
