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May 28, 1997

Prognostic Implications of Elevated Creatine Kinase After Coronary Angioplasty-Reply

Author Affiliations

Northwestern Memorial Hospital Chicago, Ill

JAMA. 1997;277(20):1593. doi:10.1001/jama.1997.03540440027021

In Reply.  —Dr Densem expressed concern that the case and control groups were not matched. He states that late cardiac mortality could therefore be influenced by potential demographic or procedural imbalance. We wish to emphasize several points in this regard.First, the groups were evenly matched with regard to the major determinants of survival in coronary heart disease: age, sex, extent of coronary artery disease, and left ventricular function. The groups were also matched regarding the number of interventions performed, the devices used, and the month and year of the procedure. This latter aspect we believe is particularly important, as operator experience impacts on procedural success and complication rates. It is also well established that saphenous vein graft interventions are associated with a higher incidence of distal embolization.1 Therefore, any study of consecutive patients undergoing percutaneous transluminal coronary angioplasty will likely have a greater incidence of CK release with bypass graft

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