Impact of periprocedural myonecrosis on clinical events after implantation of drug-eluting stents.

BACKGROUND: High level of creatine kinase myocardial band isoenzyme (CK-MB) elevation has been associated with late mortality after coronary intervention. We sought to evaluate the impact of periprocedural myonecrosis on clinical events in patients undergoing drug-eluting stents (DES) implantation.

METHODS: A total of 1807 patients (2550 lesions) with successful DES implantation were followed for mean duration of 13 + or - 7 months. Patients with acute myocardial infarction and those with elevated CK-MB at baseline were excluded. Based on the CK-MB levels after stenting, patients were classified into three groups: group I: normal CK-MB (n=1429, 79.1%), group II: 1 to 5 times normal CK-MB (n=263, 14.6%), and group III: >5 times normal CK-MB (n=115, 6.4%). Major adverse cardiac events (MACE) were defined as cardiac death, myocardial infarction, and target lesion revascularization.

RESULTS: With increasing levels of periprocedural CK-MB, there was an increased incidence of MACE (5.0% in group I vs. 6.1% in group II vs. 10.4% in group III, p=0.010) and cardiac death (0.5% in group I vs. 1.1% in group II vs. 2.6% in group III, p=0.016). By multivariate analysis, periprocedural peak CK-MB level was independent predictor of MACE (hazard ratio 1.01, 95% confidence interval 1.00 to 1.03; p=0.044).

CONCLUSIONS: Periprocedural myonecrosis was significantly associated with subsequent adverse clinical events after DES implantation.