RESUMO
Was to investigate the prognostic significance of time-delay to peak creatine kinase [CK] after successful direct percutaneous coronary intervention [PCI] in patients with acute myocardial infarction [AMI]. Our 240 consecutive first AMI attack subjects admitted within 5 hours from onset were successfully reperfused by direct PCI therapy. Subjects were divided into two groups according to the upper quartile value of peak-CK time from onset, the early peak-CK group [peak-CK time >/= 16 hours from onset, n=180] and the late peak-CK group [peak-CK time >/= 16 hours, n=60]. [I] The early ST-segment resolution rate was lower in the late peak-CK group compared with the early peak-CK group [p<0.05], and there were significantly fewer patients with preinfarction angina pectoris in the late peak-CK group than in the early peak-CK group [p<0.01]. [II] LVEF in the chronic stage was significantly lower in the late peak-CK group than in the early peak-CK group [49 +/- 13% versus 57 +/- 13%, p<0.001]. [III] There were significantly more patients with major complications in the late peak-CK group than in the early peak-CK group [required CABG: 10% versus 3%, p<0.05; cardiac death: 18% versus 3%, p=0.0001]. [IV] Multivariate analysis identified late peak-CK as an independent predictor of cardiac death [Odds ratio 7.91, 95% C.I. 1.40-44.11, p<0.05]. In patients with AMI, the time-delay to peak-CK after successful direct PCI may be closely related to left-ventricular systolic dysfunction and poor patient outcome, including mortality