Predictive value of peak creatine kinase for intramyocardial hemorrhage after percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction
Predictive value of peak creatine kinase for intramyocardial hemorrhage after percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction
Objective To investigate the predictive value of peak creatine kinase(CK)for intramyocardial hemorrhage(IMH)in ST-segment elevation myocardial infarction(STEMI)patients undergoing primary percutaneous coronary intervention(PCI).Methods A total of 241 STEMI patients who underwent PCI in Beijing Luhe Hospital,Capital Medical University from October 2019 to October 2022 were included.Cardiac magnetic resonance(CMR)imaging was performed within 1 week after PCI to assess IMH and microvascular obstruction(MVO),and clinical data were retrospectively analyzed.Creatine kinase(CK)and creatine kinase isoenzyme(CK-MB)were measured every 6 hours after admission for 24 h and peak values were obtained.The area under the receiver operating characteristic(ROC)curve was used to assess the predictive value of peak CK and peak CK-MB for IMH,the best predictive cut-off value of peak CK was calculated.Based on the cut-off value,patients were divided into two groups,and the differences in clinical characteristics between the two groups were compared.Multiple logistic regression analysis was used to analyze the factors influencing IMH in STEMI patients after PCI.Results The efficacy of peak CK in predicting IMH in STEMI patients who underwent PCI was higher than that of peak CK-MB(AUC=0.757,95％CI:0.694-0.820 vs.AUC=0.710,95％CI:0.643-0.777),and had a statistical significance(P=0.014).The optimal cut-off value for peak CK was 2 351 U/L,with sensitivity of 83.0％and specificity of 58.9％.Patients were divided into two groups with peak CK＜2 351 U/L(n=108)and ≥2 351 U/L(n=133).Compared with the CK peak＜2 351 U/L group,the proportion of men,heart rate at admission,admission glucose,absolute neutrophil value,blood uric acid,proportion of anterior infarction,proportion of preoperative thrombolysis in myocardial infarction(TIMI)flow≤grade 2,proportion of IMH(55.6％vs.13.9％)and MVO(60.2％vs.16.7％)were significantly higher in the CK peak≥ 2 351 U/L group,while age were younger and LVEF were lower,with statistically significant differences(P＜0.05).Multiple logistic regression analysis showed that anterior infarction(OR=2.105,95％CI:1.321-5.338,P=0.026),preoperative TIMI ≤ grade 2(OR=8.908,95％CI:1.029-17.148,P=0.037),peak CK ≥2 351 U/L(OR=5.543,95％CI:2.823-10.896,P＜0.001)were all independent predictors of IMH after PCI in STEMI patients.Conclusions Peak CK can effectively predict the occurrence of IMH after PCI in STEMI patients,peak CK≥2 351 U/L,anterior wall infarction,and preoperative TIMI≤grade 2 were associated with the occurrence of IMH.
关键词
肌酸激酶/心肌内出血/ST段抬高型心肌梗死/经皮冠状动脉介入/预测价值
Key words
Creatine kinase/Intramyocardial hemorrhage/ST-segment elevation myocardial infarction/Percutaneous coronary intervention/Predictive value
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