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Minor CK-MB Elevations Associated with Worse Cardiac Outcomes
The importance of slight increases in the creatine kinase cardiac-specific isoenzyme, CK-MB, in patients with chest pain but no ST-segment elevation is unclear. Researchers retrospectively analyzed data from a trial for antiplatelet therapy to determine the prognostic importance of minor elevations of CK-MB among patients with acute coronary syndromes. This analysis focused on patients who did not have ST-segment elevation but had at least 1 CK-MB sample collected during hospitalization.
Of these 8250 patients, 42 percent had normal CK-MB levels, 18 percent had levels 1 to 2 times the normal upper limit, and the remainder had even higher levels. Mortality at 30 days and 6 months correlated with the magnitude of CK-MB elevations. For example, 30-day mortality among patients with normal CK-MB levels was 1.8 percent, but 30-day mortality for those with elevated CK-MB levels was significantly higher: 3.3 percent at 1 to 2 times normal, 4.3 percent at 2 to 3 times normal, 5.1 percent at 3 to 5 times normal, 6.7 percent at 5 to 10 times normal, and 8.3 percent at higher than 10 times normal. Cardiovascular complications also correlated with peak CK-MB.
Comment: The key finding of this analysis is that even minor elevations of CK-MB differentiate patients with increased risk for cardiac complications, presumably because these increases identify small occurrences of myocardial injury.
— TH Lee
Published in Journal Watch General Medicine January 28, 2000
Citation(s):
Alexander JH et al. Association between minor elevations of creatine kinase-MB level and mortality in patients with acute coronary syndromes without ST-segment elevation. JAMA 2000 Jan 19 283 347-353.
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