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Minor myocardial damage and prognosis: are spontaneous and percutaneous coronary intervention-related events different?

Publication ,  Journal Article
Akkerhuis, KM; Alexander, JH; Tardiff, BE; Boersma, E; Harrington, RA; Lincoff, AM; Simoons, ML
Published in: Circulation
February 5, 2002

BACKGROUND: The relevance of the adverse prognostic implications of CK-MB elevation after percutaneous coronary intervention (PCI) remains controversial. Therefore, we compared the relationship between the level of postprocedural CK-MB elevation and 6-month mortality in patients undergoing PCI with the relationship between the level of spontaneous, non-PCI-related CK-MB elevation and 6-month mortality in patients with acute coronary syndromes (ACS) treated medically. METHODS AND RESULTS: In the PURSUIT trial, 5583 of 9461 patients who presented with a non-ST-elevation ACS did not undergo PCI or CABG and had at least 1 CK-MB sample collected during index-hospitalization. There was a gradual increase in 6-month mortality with higher CK-MB levels: 4.1%, 8.6%, 9.0%, 14.3%, 15.5% for CK-MB ratios 0 to 1, >1 to 3, >3 to 5, >5 to 10, and >10 times the upper limit of normal. A combined analysis in 8838 patients undergoing PCI in 5 large, clinical trials revealed a proportional relationship between postprocedural CK-MB levels (1 to 3, >3 to 5, >5 to 10, and >10, the risk of death was 1.3%, 2.0%, 2.3%, 4.3%, and 7.4%, respectively. The absolute mortality rates were lower after procedure-related infarcts compared with spontaneous infarcts. Yet, the relative increase in 6-month mortality with each increase in peak CK-MB level was similar for PCI-related myocardial necrosis and spontaneous myocardial necrosis, as all tests for heterogeneity of the odds ratios were nonsignificant. CONCLUSIONS: The present analysis indicates that the adverse prognostic implications of periprocedural myocardial necrosis should be considered similar to the adverse consequences of spontaneous myocardial necrosis.

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Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

February 5, 2002

Volume

105

Issue

5

Start / End Page

554 / 556

Location

United States

Related Subject Headings

  • Survival Rate
  • Survival Analysis
  • Risk Assessment
  • Retrospective Studies
  • Randomized Controlled Trials as Topic
  • Prognosis
  • Predictive Value of Tests
  • Postoperative Period
  • Platelet Aggregation Inhibitors
  • Peptides
 

Citation

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Akkerhuis, K. M., Alexander, J. H., Tardiff, B. E., Boersma, E., Harrington, R. A., Lincoff, A. M., & Simoons, M. L. (2002). Minor myocardial damage and prognosis: are spontaneous and percutaneous coronary intervention-related events different? Circulation, 105(5), 554–556. https://doi.org/10.1161/hc0502.104278
Akkerhuis, K Martijn, John H. Alexander, Barbara E. Tardiff, Eric Boersma, Robert A. Harrington, A Michael Lincoff, and Maarten L. Simoons. “Minor myocardial damage and prognosis: are spontaneous and percutaneous coronary intervention-related events different?Circulation 105, no. 5 (February 5, 2002): 554–56. https://doi.org/10.1161/hc0502.104278.
Akkerhuis KM, Alexander JH, Tardiff BE, Boersma E, Harrington RA, Lincoff AM, et al. Minor myocardial damage and prognosis: are spontaneous and percutaneous coronary intervention-related events different? Circulation. 2002 Feb 5;105(5):554–6.
Akkerhuis, K. Martijn, et al. “Minor myocardial damage and prognosis: are spontaneous and percutaneous coronary intervention-related events different?Circulation, vol. 105, no. 5, Feb. 2002, pp. 554–56. Pubmed, doi:10.1161/hc0502.104278.
Akkerhuis KM, Alexander JH, Tardiff BE, Boersma E, Harrington RA, Lincoff AM, Simoons ML. Minor myocardial damage and prognosis: are spontaneous and percutaneous coronary intervention-related events different? Circulation. 2002 Feb 5;105(5):554–556.

Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

February 5, 2002

Volume

105

Issue

5

Start / End Page

554 / 556

Location

United States

Related Subject Headings

  • Survival Rate
  • Survival Analysis
  • Risk Assessment
  • Retrospective Studies
  • Randomized Controlled Trials as Topic
  • Prognosis
  • Predictive Value of Tests
  • Postoperative Period
  • Platelet Aggregation Inhibitors
  • Peptides