Minke H.T. Hartman1, Ruben N. Eppinga1, Pieter J. Vlaar1, Chris P. H. Lexis1, Erik Lipšic1, Joost D.E. Haeck2, Dirk J. van Veldhuisen1, Iwan C. C. van der Horst3, Pim van der Harst1
1Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
2Department of Cardiology, Academic Medical Center Amsterdam University of Amsterdam Amsterdam the Netherlands
3Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
Tóm tắt
BackgroundComplex multimarker approaches to predict outcome after ST‐elevation myocardial infarction (STEMI) have only considered a single baseline sample, while neglecting easily obtainable peak creatine kinase and creatine kinase‐MB (CK‐MB) values during hospitalization.MethodsWe studied 476 patients undergoing primary percutaneous coronary intervention for STEMI and cardiac magnetic resonance imaging (CMRI) at 4‐6 months after STEMI. We determined the association with cardiac biomarkers (peak CK‐MB, peak troponin T, N‐terminal pro‐brain natriuretic peptide), clinical and angiographic characteristics with infarct size, and LVEF, followed by association with mortality in 1120 STEMI patients.ResultsPeak CK‐MB was the strongest predictor for infarct size (P<0.001, R
2=0.60) and LVEF (P<0.001, R
2=0.40). The additional value of clinical and angiographic characteristics was limited. The optimal peak CK‐MB cutpoints, for differentiation among small (<10% of the left ventricle), moderate (≥10%–<30%), and large infarct size (≥30%), were 210 U/L and 380 U/L, respectively. These cutpoints were associated with 90‐day mortality; the hazard ratio for moderate infarct was 2.99 (95% confidence interval [CI]: 1.51‐5.93, P=0.002) and for large infarct 6.53 (95% CI: 3.63‐11.76, P<0.001).ConclusionsClassical peak CK‐MB measured during hospitalization for STEMI was superior to other clinical and angiographic characteristics in predicting CMRI‐defined infarct size and LVEF, and should be included and validated in future multimarker studies. Peak CK‐MB cutpoints differentiated among infarct size categories and were associated with increased 90‐day mortality risk.
