Department of Cardiology, Busan Paik Hospital, University of Inje College of Medicine, Busan, Korea.
Catheter Cardiovasc Interv. 2013 May;81(6):959-67. doi: 10.1002/ccd.24542. Epub 2012 Nov 14.
To assess whether different degrees of creatine kinase-myocardial band isoenzyme (CK-MB) elevation after percutaneous coronary intervention (PCI) affect the subsequent risk of death.
While there is consensus that extensive cardiac enzyme elevation increase mortality significantly, there is uncertainty about the exact clinical impact of smaller CK-MB elevations after PCI.
The published literature was scanned by formal searches of electronic databases such as PubMed and MEDLINE from January 1999 to October 2011. Risk ratio (RR) was used as summary estimate.
Ten studies have been included totaling 48,022 patients who underwent PCI (12,246 patients with CK-MB elevation and 35,776 patients without CK-MB elevation). Mean followup duration for each study ranged from 6 to 48 months. CK-MB elevation >1× the upper limit of normal (ULN) conferred a significant increase in the risk of mortality with an overall RR of 1.74 (95% confidence interval [CI], 1.42 to 2.13, P < 0.001). Compared with patients without CK-MB elevation, there was a dose-response relationship with RR for death being 1.48 (95% CI, 1.25-1.77, P < 0.001) with CK-MB elevation 1 to <3× ULN, 1.71 (95% CI, 1.23-2.37, P = 0.001) with CK-MB elevation 3 to 5× ULN, and 2.83 (95% CI, 1.98-4.04, P < 0.001) with CK-MB elevation ≥ 5× ULN.
Even a small increase in CK-MB levels after PCI is associated with significantly higher risk of late mortality. Monitoring cardiac enzymes after PCI may help predict the long term clinical outcome.
评估经皮冠状动脉介入治疗（PCI）后肌酸激酶同工酶（CK-MB）升高的不同程度是否会影响随后的死亡风险。
虽然广泛的心肌酶升高显著增加死亡率已达成共识，但对于 PCI 后较小的 CK-MB 升高的确切临床影响仍存在不确定性。
通过正式搜索电子数据库（如 PubMed 和 MEDLINE），从 1999 年 1 月至 2011 年 10 月检索文献。使用风险比（RR）作为汇总估计值。
共纳入了 10 项研究，总计 48022 例接受 PCI 的患者（CK-MB 升高患者 12246 例，CK-MB 不升高患者 35776 例）。每项研究的平均随访时间为 6 至 48 个月。CK-MB 升高超过正常上限（ULN）1 倍以上与死亡率显著增加相关，总 RR 为 1.74（95%置信区间[CI]，1.42 至 2.13，P<0.001）。与 CK-MB 不升高的患者相比，RR 呈剂量反应关系，CK-MB 升高 1 至 <3×ULN 的 RR 为 1.48（95%CI，1.25-1.77，P<0.001），CK-MB 升高 3 至 5×ULN 的 RR 为 1.71（95%CI，1.23-2.37，P=0.001），CK-MB 升高≥5×ULN 的 RR 为 2.83（95%CI，1.98-4.04，P<0.001）。
即使 PCI 后 CK-MB 水平略有升高，也与晚期死亡率显著升高相关。PCI 后监测心肌酶可能有助于预测长期临床结局。
