Prognostic Significance of Time Between Balloon and Peak CK-MB in AMI Patients Undergoing Primary PCI

Abstract

Background: Peak creatine kinase-MB (CK-MB) level is an established predictor of clinical outcomes following acute myocardial infarction (AMI). However, the significance of the duration between balloon inflation and peak CK-MB level (BP time) after primary percutaneous coronary intervention (PCI) remains underexplored in terms of prognostic impact.

Objectives: This study aimed to elucidate the relationship between BP time and prognostic outcomes in patients with AMI.

Methods: In this multicenter observational study, 935 AMI patients who underwent primary PCI and achieved TIMI flow grade 3 on final angiography were included. CK-MB levels were measured systematically at admission and at 3-hour intervals post-PCI. Based on a BP time threshold of 553 minutes, patients were categorized into 2 groups: the long BP-time group (n = 183) and the short BP-time group (n = 752).

Results: The mean age of the patients was 67 years, with a median BP time of 334 minutes (Q1-Q3: 248-491 minutes). The long BP-time group exhibited a higher prevalence of male patients and a history of prior PCI. Cardiovascular mortality was significantly greater in the long BP-time group (log-rank test: P = 0.002). Multivariable Cox regression analysis indicated that a prolonged BP time was independently associated with increased cardiovascular mortality (HR: 2.63; 95% CI: 1.19-5.78).

Conclusions: Our findings reveal a significant association between BP time and 1-year cardiovascular mortality in patients with AMI. As a readily assessable parameter, BP time can be a valuable tool for early mortality risk stratification in patients post-primary PCI. (Prognostic Implications of Time between Balloon to Peak Creatinine Kinase-MB in patients with Acute Myocardial Infarction Undergoing Primary PCI: Multicenter Cohort Study; UMIN000049942).

Keywords: acute myocardial infarction; creatine kinase-MB; percutaneous coronary intervention; prognosis.

Graphical abstract

Central Illustration

Time Between Balloon and Peak Creatine Kinase-MB Analysis in Patients With Acute Myocardial Infarction The top left panel defines critical time intervals in acute myocardial infarction (AMI) management. The top right panel summarizes the study methodology. The bottom left panel shows the distribution of time between balloon and peak CK-MB (BP time) in the study population. The Kaplan-Meier curves (bottom right) demonstrate that the long BP-time group (red line) had a significantly lower cardiovascular mortality-free survival rate compared with the short BP-time group (blue line). CK-MB = creatine kinase-MB isoenzyme; PCI = percutaneous coronary intervention.

Figure 1

Study Population Of 1,416 acute myocardial infarction (AMI) patients, 935 were included after excluding those without primary percutaneous coronary intervention (PCI), unknown AMI onset time, patients with creatine kinase-MB isoenzyme (CK-MB) values that peaked at the time of admission, or post-percutaneous coronary intervention (PCI) TIMI flow grade <3. Patients were divided into long (n = 183) and short (n = 752) time between balloon and peak CK-MB (BP-time) groups using a 553-minute cutoff.

Figure 2

Kaplan-Meier Curves for Clinical Outcomes Kaplan-Meier curves comparing long time between balloon and peak CK-MB (BP-time) (red) and short BP-time (blue) groups for (A) all-cause mortality and (B) target vessel revascularization at 1-year follow-up.