Yale: Acute Coronary Syndrome: Importance of Elevated CPK-MB

CONTENTS

Yale University
School of Medicine
333 Cedar Street
New Haven, CT
06510 USA

(203) 432-1333

Yale

Prognostic Importance of Elevated CPK-MB Levels

Biochemical detection of myocardial injury correlates with a higher risk of mortality in patients presenting with an acute coronary syndrome. It is now evident that even the smallest levels of CPK-MB elevation confers an increased risk of subsequent mortality.

Alexander et al. examined the relationship between maximal CK-MB, as multiples of the upper limit of normal (ULN) and mortality at 30 days and 6 months in 9529 patients with non-ST elevation acute coronary syndrome [1]. The authors found that the risk of 30-day and 6-month mortality was directly proportional to peak CK-MB levels (P < 0.001 for trend). Even trivial elevations of CK-MB (1-2 x ULN) were prognostically important.

Fig. 1. CK-MB levels as predictors of mortality.

Fig. 1 Alexander JH, et al. Circulation 1998: 1-629.

Thus, patients with any degree of CK-MB elevation should be stratified into a higher risk category and considered candidates for aggressive intervention.

1. Alexander JH, Sparapani RA, Mahaffey KW, et al. 30-Day and 6-Month Mortality is Proportional to the Magnitude of Peak Creatine Kinase Elevation in the Non-ST Elevation Acute Coronary Syndrome [Abstract]. Circulation 1998 (suppl): 1629.