Elevated creatine kinase-MB with normal creatine kinase predicts worse outcomes in patients with acute coronary syndromes: results from 4 large clinical trials.

Abstract

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 25,960 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 = 19,558) 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.

• Authors: John M Galla, Kenneth W Mahaffey, Shelly K Sapp, John H Alexander, Matthew T Roe, E Magnus Ohman, Christopher B Granger, Paul W Armstrong, Robert A Harrington, Harvey D White, Maarten L Simoons, L Kristin Newby, Robert M Califf, Eric J Topol
• Journal: American heart journal (Am Heart J) Vol. 151 Issue 1 Pg. 16-24 (Jan 2006) ISSN: 1097-6744 [Electronic] United States
• PMID: 16368286 (Publication Type: Journal Article)

Chemical References

• Creatine Kinase
• Creatine Kinase, MB Form

Topics

• Acute Disease
• Aged
• Angina, Unstable (blood, drug therapy, mortality)
• Clinical Trials as Topic
• Creatine Kinase (blood)
• Creatine Kinase, MB Form (blood)
• Female
• Humans
• Male
• Middle Aged
• Myocardial Infarction (blood, drug therapy, mortality)
• Predictive Value of Tests
• Prognosis
• Syndrome