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Usefulness of periprocedural creatinine phosphokinase-MB release to predict adverse outcomes after intracoronary radiation therapy for in-stent restenosis.

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.
AuthorsAndrew 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
JournalThe American journal of cardiology (Am J Cardiol) Vol. 93 Issue 3 Pg. 313-7 (Feb 01 2004) ISSN: 0002-9149 [Print] United States
PMID14759380 (Publication Type: Evaluation Study, Journal Article, Research Support, Non-U.S. Gov't)
Chemical References
  • Isoenzymes
  • Creatinine
  • Creatine Kinase
  • Creatine Kinase, MB Form
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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