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Incidence, correlat...
Incidence, correlates, and significance of abnormal cardiac enzyme rises in patients treated with surgical or percutaneous based revascularisation : A substudy from the Synergy between Percutaneous Coronary Interventions with Taxus and Cardiac Surgery (SYNTAX) Trial
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Farooq, Vasim (author)
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Serruys, Patrick W. (author)
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Vranckx, Pascal (author)
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Bourantas, Christos V. (author)
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Girasis, Chrysafios (author)
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Holmes, David R. (author)
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Kappetein, Arie Pieter (author)
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Mack, Michael (author)
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Feldman, Ted (author)
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Morice, Marie Claude (author)
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Colombo, Antonio (author)
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Morel, Marie-angele (author)
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de Vries, Ton (author)
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Dawkins, Keith D. (author)
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Mohr, Friedrich W. (author)
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- James, Stefan (author)
- Uppsala universitet,Kardiologi,Uppsala kliniska forskningscentrum (UCR)
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- Ståhle, Elisabeth (author)
- Uppsala universitet,Thoraxkirurgi
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(creator_code:org_t)
- Elsevier BV, 2013
- 2013
- English.
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In: International Journal of Cardiology. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 168:6, s. 5287-5292
- Related links:
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https://urn.kb.se/re...
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https://doi.org/10.1...
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Abstract
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- Aims: The aimof the present investigationwas to determine the long-termprognostic association of post-procedural cardiac enzyme elevation within the randomised Synergy between Percutaneous Coronary Intervention (PCI) with TAXUS and Cardiac Surgery (SYNTAX) Trial. Methods: 1800 patients with unprotected left main or de novo three-vessel coronary artery disease were randomised to undergo coronary artery bypass graft (CABG) surgery or PCI. Per protocol patients underwent post-procedural blood sampling with creatine kinase (CK), and the cardiac specific MB iso-enzyme (CK-MB) only if the preceding CK ratiowas = 2x the upper limit of normal (ULN). An independent chemistry laboratory evaluated all collected blood samples. Results: Post-procedural CK sampling was available in 1629 of 1800 patients (90.5%). As per protocol, CK-MB analyses were undertaken in 474 of 491 patients (96.5%) in the CABG arm, and 53 of 61 patients (86.9%) in the PCI arm. Within the CABG arm, despite the limitations of incomplete data, a post-procedural CK-MB ratio <3/>= 3 ULNseparated 4-year mortality into low-and high-risk groups (2.3% vs. 9.5%, p = 0.03). Additionally, in the CABG arm, a post-procedural CK-MB ratio = 3 ULN was associated with an increased frequency of a high SYNTAX Score (= 33) tertile (high [>= 33] SYNTAX Score: 39.5%, intermediate [23-32] SYNTAX Score 31.0%, low [>= 22] SYNTAX Score 29.5%, p = 0.02). Within the PCI arm, a post-procedural CK ratio of >2 or >= 2 ULN separated 4-year mortality into low-and high-risk groups (10.8% vs. 23.3%, p = 0.001). Notably, there was an early (within 6 months) and late (after 2 years) peak in mortality in patients with a post-PCI CK ratio of = 2 ULN. Lack of pre-procedural thienopyridine, carotid artery disease, type 1 diabetes, andpresenceof coronary bifurcationswere independent correlates of a CK ratio = 2 ULNpost-PCI. Conclusion: Cardiac enzyme elevations post-CABG or post-PCI are associatedwith an adverse long-termmortality; the causes of which are multifactorial.
Keyword
- SYNTAX
- Biomarkers
- CABG
- PCI
- Mortality
Publication and Content Type
- ref (subject category)
- art (subject category)
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Farooq, Vasim
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Serruys, Patrick ...
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Vranckx, Pascal
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Bourantas, Chris ...
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Girasis, Chrysaf ...
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Holmes, David R.
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show more...
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Kappetein, Arie ...
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Mack, Michael
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Feldman, Ted
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Morice, Marie Cl ...
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Colombo, Antonio
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Morel, Marie-ang ...
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de Vries, Ton
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Dawkins, Keith D ...
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Mohr, Friedrich ...
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James, Stefan
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Ståhle, Elisabet ...
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International Jo ...
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Uppsala University