Implication of different CK and CKMB levels for clinical outcomes and prognosis in patients presenting with acute coronary syndromes without ST- segment elevation
Keywords:
Acute Coronary syndrome, Troponin, PrognosisAbstract
The new definition of acute myocardial infarction includes acute coronary
syndrome (ACS) with elevated troponin levels in patients without ST
– segment elevation (NSTEMI). The world of patients with myocardial
necrosis now diagnosed is much larger and we need to study the evolution of this new entity.
Objectives: The present study aimed to determine the influence of
elevated CK and CKMB levels in acute coronary syndromes with elevated
troponin levels in patients presenting without ST-segment elevation, in
terms of clinical characteristics, evolution and prognosis.
Methods: For 8 months, we studied sequentially all new admissions
of patients with ACS – NSTEMI with elevated troponin levels in our
Intensive Care Unit. We compared the population with a CK and CK-MB
pathologically elevated level (both: CK level more then twice its normal
maximal level and a CKMB level greater than10% of CK level) with the
group of patients with no elevation of these markers. Patients with
elevation of only one parameter (CK or CK-MB) were included in the
second group. The two groups were compared in terms of risk factors,
previous history, clinical and angiographical characteristics and evolution at 30 days and 6 months.
Results: From the 75 patients with ACS-NSTEMI (52 men), with the
mean age of 68.4 +-10.4 years, 43 (57%) had elevated CK and CKMB
levels and the other 32 had elevated troponin levels without elevation of CK and CKMB levels.
Comparing the two groups, they were similar in terms of age, gender,
cardiovascular risk factors, but those without CK elevation levels had
more frequently a previous myocardial infarction (31 versus 19, p<0.05).
The coronary morphology was not different, and the clinical evolution
was similar, at 30 days and after 6 months. There was no significant
difference in terms of re-infarction, need for revascularization and coronary mortality. However, there was a significantly positive correlation between previous myocardial infarction and the total cardiovascular mortality (0.43, p<0.01).
Conclusions: ACS-NSTE with elevated troponin level is a new entity
with a similar evolution to the previously described non-Q wave infarction.
The prognosis is the same whether or not there is an elevation of CK
and CKMB levels.
In our study, we verified that ACS – NSTEMI without elevated CK
and CKMB levels presented more frequently in patients with previous
infarction (p<0.05), and there was a positive correlation with total cardiovascular mortality at 6 months (p<0.01) in this group of patients.
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