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Am J Cardiol. 2015 Mar 1;115(5):563-70. doi: 10.1016/j.amjcard.2014.12.008. Epub 2014 Dec 18.

Utility of peak creatine kinase-MB measurements in predicting myocardial infarct size, left ventricular dysfunction, and outcome after first anterior wall acute myocardial infarction (from the INFUSE-AMI trial).

Author information

1
Columbia University Medical Center and New York-Presbyterian Hospital, New York, New York; Cardiovascular Research Foundation, New York, New York.
2
Columbia University Medical Center and New York-Presbyterian Hospital, New York, New York; Cardiovascular Research Foundation, New York, New York. Electronic address: amaehara@crf.org.
3
Cardiovascular Research Foundation, New York, New York; New York Methodist Hospital, Brooklyn, New York.
4
Columbia University Medical Center and New York-Presbyterian Hospital, New York, New York; Cardiovascular Research Foundation, New York, New York; Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada.
5
Glenfield General Hospital, Leicester, United Kingdom.
6
Cardiovascular Research Foundation, New York, New York; Icahn School of Medicine at Mount Sinai, New York, New York.
7
Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
8
Cardiovascular Research Foundation, New York, New York.

Abstract

Infarct size after ST-segment elevation myocardial infarction (STEMI) is associated with long-term clinical outcomes. However, there is insufficient information correlating creatine kinase-MB (CK-MB) or troponin levels to infarct size and infarct location in first-time occurrence of STEMI. We, therefore, assessed the utility of CK-MB measurements after primary percutaneous coronary intervention of a first anterior STEMI using bivalirudin anticoagulation in patients who were randomized to intralesion abciximab versus no abciximab and to manual thrombus aspiration versus no aspiration. Infarct size (as a percentage of total left ventricular [LV] mass) and LV ejection fraction (LVEF) were evaluated by cardiac magnetic resonance imaging at 30 days and correlated to peak CK-MB. Peak CK-MB (median 240 IU/L; interquartile range 126 to 414) was significantly associated with infarct size and with LVEF (r = 0.67, p <0.001; r = -0.56, p <0.001, respectively). A large infarct size (greater than or equal the median, defined as 17% of total LV mass) and LVEF ≤40% were more common in the highest peak CK-MB tertile group than in the other tertiles (87.6% vs 49.5% vs 9.1%, p <0.001; 43.2% vs 14.0% vs 4.6%, p <0.001, respectively). Peak CK-MB of at least 300 IU/L predicted with moderate accuracy both a large infarct size (area under the curve 0.88) and an LVEF ≤40% (area under the curve 0.78). Furthermore, CK-MB was an independent predictor of 1-year major adverse cardiac events (hazard ratio 1.42 per each additional 100 IU/L [1.20 to 1.67], p <0.001). In conclusion, CK-MB measurement is useful in estimating infarct size and LVEF and in predicting 1-year clinical outcomes after primary percutaneous coronary intervention for first anterior STEMI.

PMID:
25586335
DOI:
10.1016/j.amjcard.2014.12.008
[Indexed for MEDLINE]
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