By Sahar Bedrood B.S. and Asher Kimchi M.D.

Treviso, Italy- In patients who have ischemic heart disease, an elevated CK-MB level is indicative of tissue necrosis. Elevated CK-MB levels are frequently detected after percutaneous coronary revascularization, but few studies have correlated this increase to post-procedural mortality rates. A recent study, by Claudio Cavallini et al from the Piazza Ospedale in Treviso, Italy, collected and studied blood samples from patients undergoing percutaenous coronary intervention (PCI). In a study published in the August 2005 issue of European Heart Journal, researchers found that post-procedural elevation of CK-MB, but not cTnI, are associated with an increased two-year mortality. 

The CK-MB and PCI study was a multi-center prospective cohort study of a consecutive series of patients undergoing PCI, which was designed to evaluate the procedural elevations in CK-MB ad cTnI on long-term mortality. The study included 3494 consecutive patients undergoing PCI. Blood samples were collected from baseline, and at 8-12 and 18-24 hours after the procedure. 

CK-MB elevation was detected in 16% of the patients, and was associated with increased 2-year mortality [7.2 vs. 3.8%; odds ratio (OR): 1.9; 95% confidence interval (CI): 1.3–2.8; P<0.001). The degree of CK-MB elevation (peak CK-MB ratio) independently predicted the risk of death (adjusted OR per unit: 1.04; 95% CI: 1.01–1.07; P=0.009). A cTnI elevation was detected in 44.2% of the cases and was not associated with a significant increase in mortality (4.9 vs. 4.0%; OR: 1.2; 95% CI: 0.9–1.7; P=0.2). 

Percutaneous Coronary Revascularization has become widely used procedure for ischemic heart disease. The major finding of this study found that procedural elevations in CK-MB affect 2-year mortality and there is a linear relationship between the degree of elevation and the risk of death. It is, thus, imperative that the CK-MB levels be monitored closely following such procedures in order to evaluate a patient’s risk profile and prognosis.  

Co-authors: Claudio Cavallini, Stefano Savonitto, Roberto Violini, Gustavo Arraiz, Mario Plebani, Zoran Olivari, Paolo Rubartelli, Salvatore Battaglia, Luigi Niccoli, Giuseppe Steffenino, Diego Ardissino on behalf of the Italian ‘Atherosclerosis, Thrombosis, and Vascular Biology’ and ‘Society for Invasive Cardiology—GISE’ Investigators