18 Jul PCI – Angioplasty: Monitoring Risk Using CK-MB
MedicalResearch.com: What are the main findings of the study?
We completed a best evidence topic in interventional cardiac surgery to investigate the significance of elevated markers of cardiac damage following percutaneous coronary intervention (PCI).
We compared the clinical and prognostic relevance of the elevation of creatinine kinase-myocardial band (CK-MB) and cardiac troponin (cTn) levels during peri-procedural period and post-procedural period, respectively, following an emergency or elective PCI.
We found in excess of 390 papers after a systematic literature search, of which 10 represented the best evidence to answer the clinical question. From the best evidence available we showed that the monitoring of cardiac biomarkers following PCI can provide important clinical information about the health of the myocardium, as well as prognostic information on short to mid-term outcomes of mortality up to 3 years.
The narrow evidence base advocates the use of peri-procedural CK-MB monitoring; recommending that an elevation in CK-MB is a significant predictor of adverse events. Troponins remain a precise and reliable marker of cardiac damage; however current evidence argues that cTn holds little prognostic relevance until the degree of elevation is almost 5 times the upper limit of normal (ULN).
Thus, the best evidence recommends the use of peri-procedural CK-MB routinely during and following PCI to provide clinical and prognostic information about the degree of myocardial injury and risk of post-procedural morbidity and mortality.
MedicalResearch.com: Were any of the findings unexpected?
It was surprising that, despite current practice, most of the evidence advocates the use of CK-MB as opposed to cTn to predict morbidity and mortality following emergency and elective PCI. It was also unexpected to show that there is a limited evidence base surrounding this topic – as it would seem – improved understanding of complications following PCI is of vital importance, both clinically to enable clinicians to instigate step-up care/step down care and for the delivery of an effective and co-ordinated health service (management of patient flow, length of hospital stay, in-patient mortality etc.)
MedicalResearch.com: What should clinicians and patients take away from your report?
Monitoring of cardiac biomarkers following emergency and elective PCI can provide important clinical information about the health of the myocardium and can provide prognostic information on short to mid-term outcomes of mortality.
The best evidence recommends the use of peri-procedural CK-MB routinely during and following emergency and elective PCI to provide clinical and prognostic information about the degree of myocardial injury and risk of post-procedural morbidity and mortality.
MedicalResearch.com:What recommendations do you have for future research as a result of this study?
Our findings are in contrast to clinical practice in most centres, in which cardiac troponins are most frequently monitored to assess for cardiac damage and to predict morbidity and mortality during and following emergency and elective PCI.
We have shown by review of the current evidence that cardiac troponins hold little prognostic relevance until the degree of elevation is almost 5 times the ULN. Future prospective studies assessing the sensitivity and specificity of CK-MB in predicting morbidity and mortality in various settings should be attempted to corroborate our findings for potential future clinical use.
Gollop ND, Dhullipala A, Nagrath N, Myint PK. Is periprocedural CK-MB a better indicator of prognosis after emergency and elective percutaneous coronary intervention compared with post-procedural cardiac troponins? Interact Cardiovasc Thorac Surg. 2013 Jul 9. [Epub ahead of print] PMID: 23842761 [PubMed – as supplied by publisher]