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Clinical outcomes after detection of elevated cardiac enzymes in patients undergoing percutaneous intervention. IMPACT-II Investigators. Integrilin (eptifibatide) to Minimize Platelet Aggregation and Coronary Thrombosis-II.

Publication ,  Journal Article
Tardiff, BE; Califf, RM; Tcheng, JE; Lincoff, AM; Sigmon, KN; Harrington, RA; Mahaffey, KW; Ohman, EM; Teirstein, PS; Blankenship, JC; Kitt, MM ...
Published in: J Am Coll Cardiol
January 1999

OBJECTIVES: We examined the relations of elevated creatine kinase (CK) and its myocardial band isoenzyme (CK-MB) to clinical outcomes after percutaneous coronary intervention (PCI) in patients enrolled in Integrilin (eptifibatide) to Minimize Platelet Aggregation and Coronary Thrombosis-II (trial) (IMPACT-II), a trial of the platelet glycoprotein IIb/IIIa inhibitor eptifibatide. BACKGROUND: Elevation of cardiac enzymes often occurs after PCI, but its clinical implications are uncertain. METHODS: Patients undergoing elective, scheduled PCI for any indication were analyzed. Parallel analyses investigated CK (n=3,535) and CK-MB (n=2,341) levels after PCI (within 4 to 20 h). Clinical outcomes at 30 days and 6 months were stratified by postprocedure CK and CK-MB (multiple of the site's upper normal limit). RESULTS: Overall, 1,779 patients (76%) had no CK-MB elevation; CK-MB levels were elevated to 1 to 3 times the upper normal limit in 323 patients (13.8%), to 3 to 5 times normal in 84 (3.6%), to 5 to 10 times normal in 86 (3.7%), and to >10 times normal in 69 patients (2.9%). Elevated CK-MB was associated with an increased risk of death, reinfarction, or emergency revascularization at 30 days, and of death, reinfarction, or surgical revascularization at 6 months. Elevated total CK to above three times normal was less frequent, but its prognostic significance paralleled that seen for CK-MB. The degree of risk correlated with the rise in CK or CK-MB, even for patients with successful procedures not complicated by abrupt closure. CONCLUSIONS: Elevations in cardiac enzymes, including small increases (between one and three times normal) often not considered an infarction, are associated with an increased risk for short-term adverse clinical outcomes after successful or unsuccessful PCI.

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Published In

J Am Coll Cardiol

DOI

ISSN

0735-1097

Publication Date

January 1999

Volume

33

Issue

1

Start / End Page

88 / 96

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Stents
  • Risk
  • Recurrence
  • Platelet Aggregation Inhibitors
  • Peptides
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Isoenzymes
 

Citation

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Tardiff, B. E., Califf, R. M., Tcheng, J. E., Lincoff, A. M., Sigmon, K. N., Harrington, R. A., … Topol, E. J. (1999). Clinical outcomes after detection of elevated cardiac enzymes in patients undergoing percutaneous intervention. IMPACT-II Investigators. Integrilin (eptifibatide) to Minimize Platelet Aggregation and Coronary Thrombosis-II. J Am Coll Cardiol, 33(1), 88–96. https://doi.org/10.1016/s0735-1097(98)00551-8
Tardiff, B. E., R. M. Califf, J. E. Tcheng, A. M. Lincoff, K. N. Sigmon, R. A. Harrington, K. W. Mahaffey, et al. “Clinical outcomes after detection of elevated cardiac enzymes in patients undergoing percutaneous intervention. IMPACT-II Investigators. Integrilin (eptifibatide) to Minimize Platelet Aggregation and Coronary Thrombosis-II.J Am Coll Cardiol 33, no. 1 (January 1999): 88–96. https://doi.org/10.1016/s0735-1097(98)00551-8.
Tardiff BE, Califf RM, Tcheng JE, Lincoff AM, Sigmon KN, Harrington RA, Mahaffey KW, Ohman EM, Teirstein PS, Blankenship JC, Kitt MM, Topol EJ. Clinical outcomes after detection of elevated cardiac enzymes in patients undergoing percutaneous intervention. IMPACT-II Investigators. Integrilin (eptifibatide) to Minimize Platelet Aggregation and Coronary Thrombosis-II. J Am Coll Cardiol. 1999 Jan;33(1):88–96.
Journal cover image

Published In

J Am Coll Cardiol

DOI

ISSN

0735-1097

Publication Date

January 1999

Volume

33

Issue

1

Start / End Page

88 / 96

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Stents
  • Risk
  • Recurrence
  • Platelet Aggregation Inhibitors
  • Peptides
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Isoenzymes