Abstract |
We aimed to analyze periprocedural creatinine phosphokinase (CPK)-MB elevation in patients treated with intracoronary radiation therapy (IRT) for in- stent restenosis (ISR) to risk stratify these patients. The clinical significance of periprocedural CPK-MB elevation after IRT for ISR is unknown. An elevated CPK-MB has been associated with increased mortality after conventional angioplasty. We evaluated 1,326 patients who were enrolled in radiation trials for ISR at the Washington Hospital Center using gamma- and beta-emitters. Patients were analyzed according to degree of CPK-MB increase within 24 hours of the index IRT procedure (normal CPK-MB, CPK-MB 1 to 3 times the upper limit of normal, or CPK- MB >3 times the upper limit of normal). Patients with CPK- MB >3 times the upper limit of normal were older (64 +/- 12 years, p = 0.04), more likely to be smokers (64%, p = 0.04), hypertensive (85%, p <0.01), and diabetic (49%, p = 0.04). The cohort with the highest CPK-MB release (CPK- MB >3 times the upper limit of normal) had significantly higher rates of adverse clinical events at 12 months ( major adverse cardiac events 40%, p <0.01), including death (9.3%, p <0.01) and late thrombosis (6.3%, p <0.01). Periprocedural CPK-MB elevation is of prognostic importance in patients treated with IRT for ISR, and its analysis appears to be mandatory to risk stratify these patients. The impact of glycoprotein IIb/IIIa antagonists in reducing periprocedural CPK-MB release awaits evaluation.
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Authors | Andrew E Ajani, Ron Waksman, Arvind K Sharma, Robert Lew, Ellen Pinnow, Daniel A Canos, Edouard Cheneau, Marco Castagna, Dong-Hun Cha, Laurent Leborgne, Lowell F Satler, Augusto D Pichard, Kenneth M Kent, Joseph Lindsay |
Journal | The American journal of cardiology
(Am J Cardiol)
Vol. 93
Issue 3
Pg. 313-7
(Feb 01 2004)
ISSN: 0002-9149 [Print] United States |
PMID | 14759380
(Publication Type: Evaluation Study, Journal Article, Research Support, Non-U.S. Gov't)
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Chemical References |
- Isoenzymes
- Creatinine
- Creatine Kinase
- Creatine Kinase, MB Form
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Topics |
- Aged
- Coronary Stenosis
(therapy, urine)
- Creatine Kinase
(metabolism)
- Creatine Kinase, MB Form
- Creatinine
(urine)
- Female
- Graft Occlusion, Vascular
(radiotherapy, urine)
- Humans
- Isoenzymes
(metabolism)
- Male
- Middle Aged
- Postoperative Complications
- Predictive Value of Tests
- Treatment Outcome
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