Saucedo J F, Mehran R, Dangas G, Hong M K, Lansky A, Kent K M, Satler L F, Pichard A D, Stone G W, Leon M B
Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, USA.
J Am Coll Cardiol. 2000 Apr;35(5):1134-41. doi: 10.1016/s0735-1097(00)00513-1.
We sought to evaluate the impact of intermediate creatine kinase-myocardial band isoenzyme (CK-MB) elevation on late clinical outcomes in patients undergoing successful stent implantation in native coronary arteries.
Elevations of CK-MB after percutaneous coronary interventions are frequent. An association between high level of CK-MB elevation (>5 times normal) and late mortality after balloon and new device angioplasty has been reported previously. However, significant controversy remains on the long-term clinical importance of lower CK-MB elevations (one to five times normal) after percutaneous coronary revascularization. Moreover, the incidence and prognostic importance of cardiac enzyme elevation after coronary stenting have not been well established.
Prospectively collected data from 900 consecutive patients (1,213 lesions) undergoing successful stenting in native vessels were analyzed. Based on the CK-MB levels after coronary stenting, patients were classified into three groups: normal group 1 (n = 585), elevation of >1 to 5 times normal group 2 (n = 238) and elevation of >5 times normal group 3 (n = 77).
Patients in group 3 had more in-hospital recurrent ischemia (p = 0.001) and pulmonary edema (p = 0.01) than patients in groups 1 and 2. Long-term clinical end points were similar between groups 1 and 2. However, patients in group 3 had an increased incidence of late mortality compared with patients in groups 2 and 1 (6.9%, 1.2% and 1.7%, respectively, p = 0.01). Multivariate analysis showed that patients with CK-MB >5 times normal after coronary stenting had an increased risk of major adverse clinical events (relative risk: 1.70, p < 0.05) and death (relative risk: 3.25, p < 0.05) that was not observed in patients with lower CK-MB rise.
Patients with CK-MB elevation >5 times normal had higher late mortality and more unfavorable event-free survival than those patients with normal or lower CK-MB rise after coronary stenting. While intermediate CK-MB elevation (>1 to 5 times normal) is frequent after coronary stenting (26%), this was not associated with an increased risk of late mortality or major adverse clinical events.
我们试图评估肌酸激酶心肌带同工酶（CK-MB）中度升高对成功进行自体冠状动脉支架植入术患者晚期临床结局的影响。
经皮冠状动脉介入治疗后CK-MB升高很常见。先前已有报道，高水平的CK-MB升高（>正常上限5倍）与球囊及新型器械血管成形术后的晚期死亡率之间存在关联。然而，对于经皮冠状动脉血运重建术后较低的CK-MB升高（正常上限1至5倍）的长期临床重要性仍存在重大争议。此外，冠状动脉支架置入术后心肌酶升高的发生率及其预后意义尚未明确。
对前瞻性收集的900例连续成功进行自体血管支架置入术的患者（1213处病变）的数据进行分析。根据冠状动脉支架置入术后的CK-MB水平，将患者分为三组：正常组1（n = 585）、升高>1至5倍正常上限组2（n = 238）和升高>5倍正常上限组3（n = 77）。
与第1组和第2组患者相比，第3组患者院内再发缺血（p = 0.001）和肺水肿（p = 0.01）的发生率更高。第1组和第2组患者的长期临床终点相似。然而，与第2组和第1组患者相比，第3组患者的晚期死亡率更高（分别为6.9%、1.2%和1.7%，p = 0.01）。多变量分析显示，冠状动脉支架置入术后CK-MB>5倍正常上限的患者发生主要不良临床事件（相对风险：1.70，p < 0.05）和死亡（相对风险：3.25，p < 0.05）的风险增加，而较低CK-MB升高的患者未观察到这种情况。
冠状动脉支架置入术后CK-MB升高>5倍正常上限的患者与CK-MB正常或升高较低的患者相比，晚期死亡率更高，无不良事件生存情况更差。虽然冠状动脉支架置入术后CK-MB中度升高（>1至5倍正常上限）很常见（26%），但这与晚期死亡率或主要不良临床事件风险增加无关。
