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May 28, 1997

Prognostic Implications of Elevated Creatine Kinase After Coronary Angioplasty

Author Affiliations

Wythenshawe Hospital Wythenshawe, Manchester, England

JAMA. 1997;277(20):1593. doi:10.1001/jama.1997.03540440027019

To the Editor.  —Dr Kong and colleagues1 presented data on a cohort of patients taken from 2812 consecutive elective coronary artery interventions and concluded that a rise in creatine kinase (CK) after the procedure was associated with an adverse prognosis. However, the group of patients in this cohort were at increased risk of further morbidity and mortality for a number of reasons unrelated to a rise in CK. First, the case group was more likely to be hypertensive and hyperlipidemic relative to the control group, putting the case group at increased of future events without coronary revascularization. The increased incidence of myocardial infarctions and previous bypass surgery also suggested more extensive disease in the case group with stenoses less than 50%, and the case group had more complex target lesions. During the procedure, complications were more prevalent in the case group with poorer degree of revascularization. Therefore, it is