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Enzyme level linked to death after angioplasty

DALLAS, Aug. 20 A test commonly used to diagnose heart attacks may also identify patients at increased risk of death after balloon angioplasty, according to a study in today's rapid access issue of Circulation: Journal of the American Heart Association.

Blood levels of the enzyme creatine kinase-MB (CK-MB) rise after a heart attack, indicating injury to the heart muscle. Measuring CK-MB is a standard diagnostic test for heart attacks. Several studies have shown that elevated CK-MB is a marker for minor heart attacks and an increased risk of cardiac death after angioplasty and other catheter-based procedures. However, the nature of the relationship between CK-MB and adverse outcomes after angioplasty remains controversial.

Researchers in this study found that people with CK-MB levels more than five times higher than normal after angioplasty or stenting have a "clinically significant" increased risk of death for three to four months after the procedure. This was particularly true for those with other risk factors such as advanced age, heart failure or kidney failure.

Study author Stephen Ellis, M.D., a study author and professor and director of invasive cardiology at the Cleveland Clinic Foundation in Ohio, says the study is one of the largest of its kind. It produced several new findings: (1) a clinically significant risk of death is associated with CK-MB levels greater than five times normal; (2) there is an early period of risk, which appears to extend three to four months after the procedure; (3) the risk is greatest for patients with the highest CK-MB levels, kidney failure, heart failure, incomplete revascularization, advanced age, and high post-procedural C-reactive protein; and (4) treatment with a statin drug may lower the risk of death after a procedure.

"From the clinician's perspective, a major question has been what to do with patients who have an increase in CK-MB after angioplasty," says Ellis. "Our data show pretty clearly
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Contact: Carole Bullock
carole.bullock@heart.org
214-706-1279
American Heart Association
19-Aug-2002


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