Elevaciones de la creatincinasa tras intervencionismo coronario

Abstract

Percutaneous revascularization has led to an important change in the treatment of patients with symptomatic ischemic heart disease in recent years. There is controversy concerning the incidence and prognostic significance of postprocedural increases in creatine kinase. The aim of this study was to assess the incidence of these elevations and the related factors and to observe the prognosis of patients with and without creatin kinase elevations. We reviewed 447 patients in whom an angioplasty was done in our department from January 1997 to June 1998, excluding 138 patients with myocardial infarction in the previous four days or unsuccessful angioplasty. Creatine kinase was measured in all patients at 0, 4, 8 and 24 hours after angioplasty. We analyzed the incidence of elevated levels of creatine kinase following coronary surgery and the characteristics of the patients in comparison with a control group made up of patients who, at a similar time had undergone a similar angioplasty procedure including, a similar vessel and type of lesion, and equivalent left ventricular function but without elevated serum levels of creatine kinase. Major adverse coronary events were defined as: cardiac death, nonfatal myocardial infarction, new revascularization and unstable angina in which hospitalization was required. Out of 309 patients studied, an elevation in creatine kinase was observed in 24 patients (7.7%). Complications related to the procedure were found in 50% of these elevations, most of which involved side branch occlusion. There were no differences with respect to the demographical or anatomical characteristics of the lesions in the groups studied. During the follow-up of 9.5 months, complications were observed in 37.5% of the group of patients with elevated creatine kinase levels and in 20% of the control group, but this difference did not achieve statistical significance. Creatine kinase elevations are produced in 7.7% of the patients after coronary angioplasty. Complications related to the procedure were observed in 50% of the cases, most being side branch occlusion and no complications were seen in the remaining patients. Continuous measurement of creatine kinase after angioplasty shows a low sensitivity for detecting complications during follow-up. New, more sensitive and specific cardiac markers, such as troponin, could define this group of patients.