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- Title
Association between minor elevations of creatine kinase-MB level and mortality in patients with acute coronary syndromes without ST-segment elevation. PURSUIT Steering Committee. Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy.
- Authors
Alexander, John H.; Sparapani, Rodney A.; Mahaffey, Kenneth W.; Deckers, Jaap W.; Newby, L. Kristin; Ohman, E. Magnus; Corbalan, Ramon; Chierchia, Sergio L.; Boland, Jean B.; Simoons, Maarten L.; Califf, Robert M.; Topol, Eric J.; Harrington, Robert A.; Alexander, J H; Sparapani, R A; Mahaffey, K W; Deckers, J W; Newby, L K; Ohman, E M; Corbalán, R
- Abstract
<bold>Context: </bold>Controversy surrounds the diagnostic and prognostic importance of slightly elevated cardiac markers in patients with acute coronary syndromes without ST-segment elevation.<bold>Objectives: </bold>To investigate the relationship between peak creatine kinase (CK)-MB level and outcome and to determine whether a threshold CK-MB level exists below which risk is not increased.<bold>Design and Setting: </bold>Retrospective observational analysis of data from the international Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy (PURSUIT) trial, conducted from November 1995 to January 1997.<bold>Patients: </bold>A total of 8250 patients with acute coronary syndromes without ST-segment elevation who had at least 1 CK-MB sample collected during their index hospitalization.<bold>Main Outcome Measure: </bold>Mortality at 30 days and 6 months, was assessed by category of index-hospitalization peak CK-MB level (0-1, >1-2, >2-3, >3-5, >5-10, or >10 times the upper limit of normal). Multivariable logistic regression was used to determine the independent prognostic significance of peak CK-MB level after adjustment for baseline predictors of 30-day and 6-month mortality.<bold>Results: </bold>Mortality at 30 days and 6 months increased from 1.8% and 4.0%, respectively, in patients with normal peak CK-MB levels, to 3.3% and 6.2 % at peak CK-MB levels 1 to 2 times normal, to 5.1% and 7.5% at peak CK-MB levels 3 to 5 times normal, and to 8.3% and 11.0% at peak CK-MB levels greater than 10 times normal. Log-transformed peak CK-MB levels were predictive of adjusted 30-day and 6-month mortality (P<.001 for both).<bold>Conclusions: </bold>Our data show that elevation of CK-MB level is strongly related to mortality in patients with acute coronary syndromes without ST-segment elevation, and that the increased risk begins with CK-MB levels just above normal. In the appropriate clinical context, even minor CK-MB elevations should be considered indicative of myocardial infarction.
- Subjects
CREATINE kinase; PHOSPHOTRANSFERASES; PROTEIN kinases; TRANSFERASES
- Publication
JAMA: Journal of the American Medical Association, 2000, Vol 283, Issue 3, p347
- ISSN
0098-7484
- Publication type
journal article
- DOI
10.1001/jama.283.3.347