scholarly journals Creatine Kinase during Non-ST-Segment Elevation Acute Coronary Syndromes is Associated with Major Bleeding

2020 ◽  
Author(s):  
Lizzy M. Brewster ◽  
Jim D. Fernand
Keyword(s):  
Creatine Kinase ◽  
Major Bleeding ◽  
Acute Coronary Syndromes ◽  
Prediction Models ◽  
Peak Plasma ◽  
St Segment Elevation ◽  
Reference Limit ◽  
St Segment ◽  
Coronary Syndromes ◽  
Plasma Activity

AbstractBackgroundIt was recently reported that highly elevated plasma activity of the ADP-scavenging enzyme creatine kinase (CK), to >10 times the upper reference limit (URL), is independently associated with fatal or non-fatal bleeding during treatment for ST-segment elevation myocardial infarction (OR 2.6 [95% CI, 1.8 to 2.7]/log CK increase). Evidence indicates that CK attenuates ADP-dependent platelet aggregation. This study investigates whether moderately elevated CK in non-ST-segment elevation acute coronary syndromes (NSTE-ACS) is associated with major bleeding.MethodsThe Thrombolysis In Myocardial Ischemia (TIMI) 3B trial compared rt-PA (35 to 80 mg) with placebo, and early catheterization with conservative management in patients with NSTE-ACS. Main outcomes of the current study are the independent association of peak plasma CK (CKmax) with adjudicated fatal or non-fatal major bleeding (primary), and with combined major bleeding, stroke, and all-cause mortality (secondary) in multivariable binomial logistic regression analysis, with co-variables including age, sex, BMI, SBP, creatinine, and treatment assignment. Discrimination was assessed with C-statistics.ResultsThe study included 1473 patients (66% men, 80% white, mean age 59 y, SE 0.3). CKmax ranged between 15 and 19045 IU/L (mean (SE), 450(24) IU/L; i.e. 2 times URL). Major bleeding occurred in 2.0% (mean age 65(1.3) y; mean CKmax 1015(318) IU/L; 6 times URL), and the combined outcome in 4.3% of the patients, adjusted OR per log CK increase respectively 3.1 [1.6 to 5.8] for major bleeding, and 3.9 [2.5 to 6.1] for the combined outcome; C-index 0.8 for both outcomes.DiscussionThe presented data add to the existing evidence that proportionate to its plasma activity, the ADP-binding enzyme CK is strongly and independently associated with non-fatal and fatal major bleeding during ACS treatment. CK might increase the accuracy of prediction models for major bleeding in patients treated with antithrombotic or thrombolytic drugs for ACS.ClinicalTrials.gov identifierNCT00000472

scholarly journals Creatine kinase during non-ST-segment elevation acute coronary syndromes is associated with major bleeding

Open Heart ◽  
2020 ◽  
Vol 7 (2) ◽  
pp. e001281
Author(s):  
Lizzy Maritza Brewster ◽  
Jim Fernand
Keyword(s):  
Creatine Kinase ◽  
Major Bleeding ◽  
Prediction Models ◽  
Peak Plasma ◽  
Tissue Type ◽  
Hospital Death ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Plasma Activity

BackgroundIt was recently reported that highly elevated plasma activity of the ADP-scavenging enzyme creatine kinase (CK), to >10 times the upper reference limit (URL), is independently associated with fatal or non-fatal bleeding during treatment for ST-segment elevation myocardial infarction (OR 2.6 (95% CI, 1.8 to 2.7)/log CK increase). Evidence indicates that CK attenuates ADP-dependent platelet aggregation. This study investigates whether moderately elevated CK in non-ST-segment elevation acute coronary syndrome (NSTE-ACS) is associated with major bleeding.MethodsThe Thrombolysis In Myocardial Ischemia (TIMI) 3B trial compared recombinant tissue-type plasminogen activator (rt-PA) (35–80 mg) with placebo and early catheterisation with conservative management in patients with NSTE-ACS. Main outcomes of the current study are the independent association of peak plasma CK (CKmax) with adjudicated fatal or non-fatal major bleeding (primary) and with combined major bleeding, stroke and hospital death (secondary), with covariables including age, sex, body mass index, systolic blood pressure, creatinine and assignment to add-on rt-PA versus placebo. Discrimination was assessed with C-statistics.ResultsThe study included 1473 patients (66% men, 80% white, mean age 59 years, SE 0.3). CKmax ranged between 15 and 19 045 IU/L (mean (SE), 450 (24) IU/L; two times URL). Major bleeding occurred in 2.0% (mean age 65 (1.3) years; mean CKmax 1015 (319) IU/L; six times URL), and the combined outcome in 4.3% of the patients, adjusted OR per log CK increase, respectively, 3.1 (1.6 to 5.9) for major bleeding and 3.9 (2.5 to 6.1) for the combined outcome; C-index 0.8 for both outcomes. The association between CK and bleeding was independent of the use of thrombolytic therapy.DiscussionThe presented data add to the existing evidence that proportionate to its plasma activity, the ADP-binding enzyme CK is strongly and independently associated with non-fatal and fatal major bleeding during treatment for NSTE-ACS. CK might increase the accuracy of prediction models for major bleeding in patients with NSTE-ACS.Trial registration numberNCT00000472.

Abstract 5598: Angiographic Evidence of Early Coronary Artery Disease and Inceased Risk of Mortality in Smokers with Non-ST-Segment Elevation Acute Coronary Syndromes: An Analysis of the ACUITY Trial

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Jason O Robertson ◽  
Ramin Ebrahimi ◽  
Alexandra J Lansky ◽  
Roxana Mehran ◽  
Gregg W Stone ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Major Bleeding ◽  
Acute Coronary Syndromes ◽  
Smoking Status ◽  
St Segment Elevation ◽  
St Segment ◽  
Acute Mi ◽  
Coronary Syndromes ◽  
Artery Disease

To determine the relationship between smoking and outcomes in a contemporary population of patients with non-ST-elevation acute coronary syndromes (NSTE-ACS). Smoking has been associated with the “paradox” of reduced mortality following acute MI. This is thought to be due to favorable baseline characteristics and less diffuse CAD of smokers. In the ACUITY trial, 13,819 patients (29.1% smokers) with moderate- to high-risk NSTE-ACS underwent angiography and, if indicated, revascularization. Smokers were significantly younger and had fewer co-morbidities than nonsmokers. Incidence of death and MI were comparable at 30-days, although smokers had significantly reduced risks of 30-day major bleeding (HR=0.80, 95% CI=0.67– 0.96, p=0.016) and 1-year mortality (HR=0.797, 95% CI=0.65– 0.97, p=0.027). After multivariate correction for baseline and clinical differences, however, smoking status was no longer predictive of major bleeding (OR=1.06, 95% CI=0.85–1.32, p =0.59) and was associated with higher 1-year mortality (HR=1.38, 95% CI=1.07–1.78, p =0.013). This pattern of reversed risk following multivariable correction held true, as well, for those smokers requiring PCI. Core laboratory angiographic analysis showed that smokers and nonsmokers were comparable in terms of the extent of coronary artery disease, TIMI flow, myocardial blush and the presence of thrombi, but smokers had significantly less coronary artery calcification and fewer collaterals. In contrast to the paradox previously described in STEMI, our analysis finds smoking to be an independent predictor of higher 1-year mortality in patients presenting with NSTE-ACS, and our angiographic study demonstrates CAD disease in smokers that is comparable to nonsmokers but evident approximately one decade earlier.

Unfractionated heparin dosing and risk of major bleeding in non–ST-segment elevation acute coronary syndromes

2008 ◽  
Vol 156 (2) ◽  
pp. 209-215 ◽  
Author(s):  
Chiara Melloni ◽  
Karen P. Alexander ◽  
Anita Y. Chen ◽  
L. Kristin Newby ◽  
Matthew T. Roe ◽  
...  
Keyword(s):  
Unfractionated Heparin ◽  
Major Bleeding ◽  
Acute Coronary Syndromes ◽  
St Segment Elevation ◽  
St Segment ◽  
Coronary Syndromes
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