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Increased CK-MB after bypass surgery a marker of worse outcome

מתוך medicontext.co.il

WESTPORT, CT (Reuters Health) – An elevated creatine kinase-MB (CK-MB) level after coronary artery bypass grafting (CABG) increases the patient's risk of death or myocardial infarction or both, according to data from a large, prospective, multicenter trial.

A total of 496 patients with multivessel coronary disease who were enrolled in the Arterial Revascularization Therapies Study (ARTS) underwent CABG. Dr. Patrick W. Serruys, of Heartcenter/Erasmus University Rotterdam in the Netherlands, and associates observed that 61.9% of patients exhibited elevated CK-MB levels within 18 hours after surgery. Levels were more than five times normal in 11.5%.

Within 30 days of surgery, the mortality rate was 7% for those whose CK-MB level exceeded five times normal, versus 0% among those with normal enzyme levels, the researchers note in the November 27th issue of Circulation. "All early deaths were cardiovascular in origin," the researchers note.

At 1 year, this patients whose CK-MB level exceeded five times normal had a 10.5% mortality rate and a 12.3% incidence of MI. The peak postoperative enzyme level was strongly associated with adverse events (p = 0.009).

Dr. Surreys' team recommends routine measurement of cardiac enzymes when patients undergo bypass surgery. Those whose CK-MB level rises to more than five times normal should be treated as a high-risk population, the researchers add.

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