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J Thorac Cardiovasc Surg 2005;129:300-306
© 2005 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Increased creatine kinase MB level predicts postoperative mortality after cardiac surgery independent of new Q waves

^a Department of Anesthesiology, Emory University Hospital, Atlanta, Ga
^b Department of Anesthesiology, Perioperative and Pain Medicine at Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
^c Department of Anesthesiology, University of Oklahoma, Oklahoma City, Okla
^d Alexion Pharmaceuticals, Inc, Cheshire, Conn
^e Procter and Gamble Pharmaceuticals, Mason, Ohio
^f Department of Cardiovascular Anesthesiology, Texas Heart Institute at Saint Luke's Episcopal Hospital, Houston, Tex

Received for publication February 11, 2004; revisions received June 3, 2004; accepted for publication June 8, 2004.

^* Address for reprints: Nancy A. Nussmeier, MD, Department of Cardiovascular Anesthesiology, Texas Heart Institute at Saint Luke's Episcopal Hospital, Houston, TX 77030 (E-mail: nnussmeier{at}heart.thi.tmc.edu).

BACKGROUND: Recent consensus statements recommend cardiac enzyme release as the essential criterion for diagnosing myocardial infarction. However, the outcome implications of cardiac enzyme release in patients undergoing coronary artery bypass grafting are controversial.

METHODS: Eight hundred patients were followed for 30 days after elective on-pump coronary artery bypass grafting in a multicenter, prospective, randomized trial of the anti-C5 complement antibody pexelizumab. Data from centralized electrocardiography and creatine kinase MB analyses were examined for any association with death or severe left ventricular dysfunction.

RESULTS: More than half of the 800 patients had peak creatine kinase MB levels of more than 5 times the upper limit of 5 ng/mL set by the core laboratory. The median peak value was 29 ng/mL. The incidence of the combined outcome (death or severe left ventricular dysfunction) was 1.7% if the peak creatine kinase MB level was less than 25 ng/mL and 18.0% if 100 ng/mL or greater (P < .01). Similarly, the incidence of new Q-wave myocardial infarction was 3.9% if the peak creatine kinase MB level was less than 25 ng/mL and 30.6% if 100 ng/mL or greater (P < .01). In a multivariate analysis that included preoperative and intraoperative factors, as well as peak enzyme release and Q-wave myocardial infarction, the strongest predictor of the combined outcome was a peak creatine kinase MB level of 100 ng/mL or greater. New Q-wave myocardial infarction did not significantly predict the combined outcome.

CONCLUSIONS: Increased postoperative peak creatine kinase MB level, especially when 20 times or more of the upper limit of normal, indicates increased risk of severe postoperative left ventricular dysfunction and mortality within 30 days of coronary artery bypass grafting. High peak enzyme level is a stronger predictor of adverse outcomes than is postoperative Q-wave myocardial infarction in this population.

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