1. Home>
2. Specialties>
3. Cardiology>
4. Summary and Comment

Minor CK-MB Elevations Increase Mortality Risk

The magnitude of CK-MB elevations has been shown to correlate with risk for major adverse outcomes in MI patients with persistent ST-segment elevation. However, the predictive role of CK-MB levels in acute coronary syndromes without ST-segment elevation has been debated. In this industry-supported, retrospective study, investigators examined 30-day and 6-month follow-up data from the PURSUIT trial for 9461 patients hospitalized with acute coronary syndromes accompanied by ST-segment depression, T-wave inversion, transient ST-segment elevation, or elevated CK-MB levels.

Patients with elevated CK-MB levels showed a significantly increased risk for both 30-day and 6-month mortality. Compared with a normal CK-MB level, an elevation of 2 to 3 times the upper range of normal correlated with a nearly twofold increase in risk for 30-day mortality; a greater than 10-fold elevation in CK-MB level correlated with a 4.5-fold increase in mortality risk. CK-MB elevations also correlated with higher risks for stroke, shock, congestive heart failure, ventricular tachycardia, heart block, and angioplasty or bypass intervention at 30 days.

Comment: This important analysis further highlights the possibility that minor CK-MB elevations may reflect ongoing vascular instability in patients with acute coronary syndromes. Several studies have suggested that recurrent platelet microemboli, with or without microscopic areas of infarction, underlie the pathophysiology of this key association.

— KA Eagle

Published in Journal Watch Cardiology February 18, 2000

Citation(s):

Alexander JH et al for the PURSUIT Steering Committee. 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.

• Original article (Subscription may be required)
• Medline abstract (Free)