Prognostic significance of elevated creatine kinase MB after coronary bypass surgery and after an acute coronary syndrome: Results from the GUARDIAN trial
(2003) In Journal of Thoracic and Cardiovascular Surgery 126(3). p.807-813- Abstract
- Objective: To determine if the correlation between magnitude of creatine kinase-myocardial band release after coronary artery bypass surgery and 6-month mortality is comparable to that of patients admitted with an acute coronary syndrome. Methods: The GUARDIAN trial tested the efficacy of cariporide, an Na+/H+ exchange inhibitor, on reduction of myocardial ischemia or death in high-risk patients. We compared 6-month survival in a cohort of 2332 GUARDIAN patients scheduled for coronary artery bypass surgery at entry with 4233 acute coronary syndrome patients stratified by level of creatine kinase-myocardial band release. Cumulative 6-month survival by creatine kinase-myocardial band categories was performed using life table analysis,... (More)
- Objective: To determine if the correlation between magnitude of creatine kinase-myocardial band release after coronary artery bypass surgery and 6-month mortality is comparable to that of patients admitted with an acute coronary syndrome. Methods: The GUARDIAN trial tested the efficacy of cariporide, an Na+/H+ exchange inhibitor, on reduction of myocardial ischemia or death in high-risk patients. We compared 6-month survival in a cohort of 2332 GUARDIAN patients scheduled for coronary artery bypass surgery at entry with 4233 acute coronary syndrome patients stratified by level of creatine kinase-myocardial band release. Cumulative 6-month survival by creatine kinase-myocardial band categories was performed using life table analysis, adjusting for variables known to impact prognosis using Cox regression. Results: The 6-month mortality rates for coronary artery bypass surgery patients with peak creatine kinase-myocardial band ratios of < 1, greater than or equal to1 and <5, greater than or equal to5 and < 10, and ! 10 upper limits of normal (ULN) were 5.8, 2.8, 5.9, and 12.0%, respectively (P < .0001). The 6-month mortality rates for acute coronary syndrome patients with peak creatine kinase-myocardial band ratios of < 1, greater than or equal to 1 and <5, greater than or equal to 5 and < 10, and greater than or equal to10 ULN were 6.3, 9.8, 10.0, and 12.3%, respectively (P < .0001). Patients with coronary artery bypass surgery or acute coronary syndrome had similar adjusted 6-month survival estimates at normal creatine kinase-myocardial band levels and when the creatine kinase-myocardial band level was greater than or equal to 10 ULN. Patients with coronary artery bypass surgery had significantly better survival at intermediate enzyme levels ( ! I and < 10 ULN; P < .001). Conclusions: Modest elevations of creatine kinase-myocardial band release (greater than or equal to 1 and <10 ULN) after coronary artery bypass surgery are not associated with adverse 6-month survival, in contrast to that seen in acute coronary syndrome patients. Routine creatine kinase-myocardial band sampling should be considered in all higher-risk patients undergoing coronary artery bypass surgery procedures to identify the sizable cohort of patients with creatine kinase-myocardial band release ! 10 ULN; these patients may benefit from postoperative angiotensin-converting enzyme inhibitor and beta-blocker therapy. Newer cardioprotective agents that reduce the number of patients with marked creatine kinase-myocardial band release are currently being tested in large randomized controlled clinical trials. (Less)
Please use this url to cite or link to this publication:
https://lup.lub.lu.se/record/899951
- author
- Gavard, JA ; Chaitman, BR ; Sakai, S ; Stocke, K ; Danchin, N ; Erhardt, Leif RW LU ; Gallo, R ; Chi, E ; Jessel, A and Theroux, P
- organization
- publishing date
- 2003
- type
- Contribution to journal
- publication status
- published
- subject
- in
- Journal of Thoracic and Cardiovascular Surgery
- volume
- 126
- issue
- 3
- pages
- 807 - 813
- publisher
- Mosby-Elsevier
- external identifiers
-
- wos:000185417200032
- pmid:14502157
- scopus:0141519212
- ISSN
- 1097-685X
- DOI
- 10.1016/S0022-5223(03)00735-9
- language
- English
- LU publication?
- yes
- id
- 85f5d444-2701-4392-a7df-877108fbf85b (old id 899951)
- date added to LUP
- 2016-04-01 16:50:20
- date last changed
- 2022-01-28 22:28:39
@article{85f5d444-2701-4392-a7df-877108fbf85b,
abstract = {{Objective: To determine if the correlation between magnitude of creatine kinase-myocardial band release after coronary artery bypass surgery and 6-month mortality is comparable to that of patients admitted with an acute coronary syndrome. Methods: The GUARDIAN trial tested the efficacy of cariporide, an Na+/H+ exchange inhibitor, on reduction of myocardial ischemia or death in high-risk patients. We compared 6-month survival in a cohort of 2332 GUARDIAN patients scheduled for coronary artery bypass surgery at entry with 4233 acute coronary syndrome patients stratified by level of creatine kinase-myocardial band release. Cumulative 6-month survival by creatine kinase-myocardial band categories was performed using life table analysis, adjusting for variables known to impact prognosis using Cox regression. Results: The 6-month mortality rates for coronary artery bypass surgery patients with peak creatine kinase-myocardial band ratios of < 1, greater than or equal to1 and <5, greater than or equal to5 and < 10, and ! 10 upper limits of normal (ULN) were 5.8, 2.8, 5.9, and 12.0%, respectively (P < .0001). The 6-month mortality rates for acute coronary syndrome patients with peak creatine kinase-myocardial band ratios of < 1, greater than or equal to 1 and <5, greater than or equal to 5 and < 10, and greater than or equal to10 ULN were 6.3, 9.8, 10.0, and 12.3%, respectively (P < .0001). Patients with coronary artery bypass surgery or acute coronary syndrome had similar adjusted 6-month survival estimates at normal creatine kinase-myocardial band levels and when the creatine kinase-myocardial band level was greater than or equal to 10 ULN. Patients with coronary artery bypass surgery had significantly better survival at intermediate enzyme levels ( ! I and < 10 ULN; P < .001). Conclusions: Modest elevations of creatine kinase-myocardial band release (greater than or equal to 1 and <10 ULN) after coronary artery bypass surgery are not associated with adverse 6-month survival, in contrast to that seen in acute coronary syndrome patients. Routine creatine kinase-myocardial band sampling should be considered in all higher-risk patients undergoing coronary artery bypass surgery procedures to identify the sizable cohort of patients with creatine kinase-myocardial band release ! 10 ULN; these patients may benefit from postoperative angiotensin-converting enzyme inhibitor and beta-blocker therapy. Newer cardioprotective agents that reduce the number of patients with marked creatine kinase-myocardial band release are currently being tested in large randomized controlled clinical trials.}},
author = {{Gavard, JA and Chaitman, BR and Sakai, S and Stocke, K and Danchin, N and Erhardt, Leif RW and Gallo, R and Chi, E and Jessel, A and Theroux, P}},
issn = {{1097-685X}},
language = {{eng}},
number = {{3}},
pages = {{807--813}},
publisher = {{Mosby-Elsevier}},
series = {{Journal of Thoracic and Cardiovascular Surgery}},
title = {{Prognostic significance of elevated creatine kinase MB after coronary bypass surgery and after an acute coronary syndrome: Results from the GUARDIAN trial}},
url = {{http://dx.doi.org/10.1016/S0022-5223(03)00735-9}},
doi = {{10.1016/S0022-5223(03)00735-9}},
volume = {{126}},
year = {{2003}},
}