AI Article Synopsis

  • The study focused on understanding the significance of elevated creatinine phosphokinase (CPK)-MB levels in patients undergoing intracoronary radiation therapy (IRT) for in-stent restenosis (ISR).
  • Researchers analyzed data from 1,326 patients, categorizing them based on their CPK-MB increase after the procedure, finding that higher levels were associated with older age, smoking, hypertension, and diabetes.
  • Patients with very high CPK-MB levels (>3 times the normal limit) had much worse outcomes at 12 months, indicating that monitoring CPK-MB is crucial for assessing the risks in these patients.

Article Abstract

We aimed to analyze periprocedural creatinine phosphokinase (CPK)-MB elevation in patients treated with intracoronary radiation therapy (IRT) for in-stent restenosis (ISR) to risk stratify these patients. The clinical significance of periprocedural CPK-MB elevation after IRT for ISR is unknown. An elevated CPK-MB has been associated with increased mortality after conventional angioplasty. We evaluated 1,326 patients who were enrolled in radiation trials for ISR at the Washington Hospital Center using gamma- and beta-emitters. Patients were analyzed according to degree of CPK-MB increase within 24 hours of the index IRT procedure (normal CPK-MB, CPK-MB 1 to 3 times the upper limit of normal, or CPK-MB >3 times the upper limit of normal). Patients with CPK-MB >3 times the upper limit of normal were older (64 +/- 12 years, p = 0.04), more likely to be smokers (64%, p = 0.04), hypertensive (85%, p <0.01), and diabetic (49%, p = 0.04). The cohort with the highest CPK-MB release (CPK-MB >3 times the upper limit of normal) had significantly higher rates of adverse clinical events at 12 months (major adverse cardiac events 40%, p <0.01), including death (9.3%, p <0.01) and late thrombosis (6.3%, p <0.01). Periprocedural CPK-MB elevation is of prognostic importance in patients treated with IRT for ISR, and its analysis appears to be mandatory to risk stratify these patients. The impact of glycoprotein IIb/IIIa antagonists in reducing periprocedural CPK-MB release awaits evaluation.

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http://dx.doi.org/10.1016/j.amjcard.2003.10.010DOI Listing

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