Infarct size after ST-segment elevation myocardial infarction (STEMI) is associated
with long-term clinical outcomes. However, there is insufficient information correlating
creatine kinase-MB (CK-MB) or troponin levels to infarct size and infarct location
in first-time occurrence of STEMI. We, therefore, assessed the utility of CK-MB measurements
after primary percutaneous coronary intervention of a first anterior STEMI using bivalirudin
anticoagulation in patients who were randomized to intralesion abciximab versus no
abciximab and to manual thrombus aspiration versus no aspiration. Infarct size (as
a percentage of total left ventricular [LV] mass) and LV ejection fraction (LVEF)
were evaluated by cardiac magnetic resonance imaging at 30 days and correlated to
peak CK-MB. Peak CK-MB (median 240 IU/L; interquartile range 126 to 414) was significantly
associated with infarct size and with LVEF (r = 0.67, p <0.001; r = −0.56, p <0.001,
respectively). A large infarct size (greater than or equal the median, defined as
17% of total LV mass) and LVEF ≤40% were more common in the highest peak CK-MB tertile
group than in the other tertiles (87.6% vs 49.5% vs 9.1%, p <0.001; 43.2% vs 14.0%
vs 4.6%, p <0.001, respectively). Peak CK-MB of at least 300 IU/L predicted with moderate
accuracy both a large infarct size (area under the curve 0.88) and an LVEF ≤40% (area
under the curve 0.78). Furthermore, CK-MB was an independent predictor of 1-year major
adverse cardiac events (hazard ratio 1.42 per each additional 100 IU/L [1.20 to 1.67],
p <0.001). In conclusion, CK-MB measurement is useful in estimating infarct size and
LVEF and in predicting 1-year clinical outcomes after primary percutaneous coronary
intervention for first anterior STEMI.
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Article info
Publication history
Published online: December 17, 2014
Accepted:
December 3,
2014
Received in revised form:
December 3,
2014
Received:
September 7,
2014
Footnotes
See page 569 for disclosure information.
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© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
