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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
- Article/chapterEnglish2013
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Elsevier BV,2013
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LIBRIS-ID:oai:DiVA.org:uu-211797
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https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-211797URI
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https://doi.org/10.1016/j.ijcard.2013.08.013DOI
Supplementary language notes
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Language:English
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Summary in:English
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Subject category:ref swepub-contenttype
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Subject category:art swepub-publicationtype
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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.
Subject headings and genre
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SYNTAX
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Biomarkers
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CABG
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PCI
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Mortality
Added entries (persons, corporate bodies, meetings, titles ...)
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Serruys, Patrick W.
(author)
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Vranckx, Pascal
(author)
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Bourantas, Christos V.
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Girasis, Chrysafios
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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, StefanUppsala universitet,Kardiologi,Uppsala kliniska forskningscentrum (UCR)(Swepub:uu)stjam367
(author)
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Ståhle, ElisabethUppsala universitet,Thoraxkirurgi(Swepub:uu)elsta102
(author)
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Uppsala universitetKardiologi
(creator_code:org_t)
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In:International Journal of Cardiology: Elsevier BV168:6, s. 5287-52920167-52731874-1754
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