What is the clinical evidence from this study?

Study design: Cohort. Population: ST-segment elevation myocardial infarction (STEMI) (n=2059). Intervention: Maximum serum creatine kinase >7098 U/L vs. Maximum serum creatine kinase ≤7098 U/L. Primary outcome: all-cause mortality (HR 3.50, 95% CI 2.31-5.31).

What does this research mean for the field?

Maximum CK levels >7098 U/L after PCI predict all-cause mortality (HR: 3.50; CI: 2.31–5.31) and reduced LV function in STEMI patients. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

What question did this study set out to answer?

To evaluate how peak serum creatine kinase levels after primary PCI relate to long-term outcomes in STEMI patients treated with second-generation drug-eluting stents.

February 6, 2026

The relationship between peak serum creatine kinase levels after PCI and long-term outcomes in patients with STEMI: a report from the STELA registry

Key Result

Maximum serum creatine kinase levels >7098 U/L after primary PCI in STEMI patients independently predicted all-cause mortality (HR 3.50; 95% CI 2.31-5.31) and reduced left ventricular function.

Key Points

To evaluate how peak serum creatine kinase levels after primary PCI relate to long-term outcomes in STEMI patients treated with second-generation drug-eluting stents.
Conducted as a sub-analysis of the STELA registry including STEMI patients undergoing primary PCI.
Involved multicenter data collection from 12 Japanese institutions between 2015 and 2019.
Calculated the area under the curve for in-hospital mortality and maximum CK levels to find a relevant cutoff point.
Performed multivariable Cox regression analysis to assess CK levels as a prognostic factor.
Included 2,059 STEMI patients with a median follow-up of 2.2 years.
Identified a cutoff value for maximum CK levels associated with in-hospital mortality at 7098 U/L.
Patients with CK levels >7098 U/L had a significantly higher all-cause mortality rate (HR: 4.10).
Confirmed that elevated CK levels are independently predictive of worse left ventricular function (44±9.8 vs. 56±10.6).

Study Design

Type

Cohort (n=2,059)

Multicenter

Yes

Structured PICO

Does a maximum serum creatine kinase level >7098 U/L after primary PCI predict increased all-cause mortality in STEMI patients?

Population

2,059 STEMI patients who underwent primary PCI within 24 hours of symptom onset at 12 Japanese institutions

Intervention

Maximum serum creatine kinase (CK) level >7098 U/L after primary PCI

Comparator

Maximum serum creatine kinase (CK) level ≤7098 U/L after primary PCI

Outcome

All-cause mortalityhard clinical

In the era of second-generation drug-eluting stents, maximum CK levels after primary PCI remain a strong independent predictor of long-term all-cause mortality and reduced LV function in STEMI patients.

Main Result

Effect estimate: HR 3.50 (95% CI 2.31-5.31)

Abstract

Abstract Background The maximum serum creatine kinase (CK) level after primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) has been recognized as an independent prognostic factor for 1-year mortality and left ventricular (LV) function. However, this evidence is based on studies conducted during the era of bare-metal stents, and it remains unclear whether this holds true in the current era dominated by second-generation drug-eluting stents (DES). Objective To evaluate the relationship between maximum CK levels after primary PCI and prognosis in the current era where second-generation DES are the standard of care. Methods This study is a sub-analysis of the STELA registry, a multicenter registry study. The STELA registry included STEMI patients who underwent primary PCI within 24 hours of symptom onset at 12 Japanese institutions capable of performing PCI 24/7, with data collected between 2015 and 2019. The area under the curve (AUC) was calculated for in-hospital mortality and maximum CK levels, and a cutoff value was determined to divide patients into two groups. All-cause mortality and LV function were analyzed. Additionally, multivariable Cox regression analysis was performed to assess the independence of the CK cutoff value as a prognostic factor for all-cause mortality. Results A total of 2,059 STEMI patients were included, with a median follow-up period of 2.2 1.1–3.9 years. The in-hospital mortality rate was 7.1%, and the overall all-cause mortality rate during the observation period was 12.3%. The cutoff value for maximum CK levels associated with in-hospital mortality was 7098 U/L (AUC: 0.70). Patients with maximum CK levels 7098 U/L were younger, predominantly male, had higher BMI, and a higher proportion of Killip class IV compared to those with lower CK levels. Angiographic findings showed a higher prevalence of culprit lesions in the proximal left anterior descending artery, as well as significantly more cases with pre-procedural TIMI flow grade 0 and thrombus TIMI grade 5. The proportion of stenting was similar between the two groups (93% vs. 90%, P=0.26), but the use of mechanical circulatory support was significantly higher in the CK 7098 U/L group (21% vs. 12%, P0.001). Procedural complications, such as the no-reflow phenomenon, were also significantly more frequent. Patients with CK 7098 U/L had significantly worse outcomes for all-cause mortality (HR: 4.10; CI: 3.19–5.27) and reduced LV function (44±9.8 vs. 56±10.6, P0.001). Multivariable analysis confirmed that CK 7098 U/L was an independent prognostic factor for all-cause mortality (HR: 3.50; CI: 2.31–5.31). Conclusion In the current era dominated by second-generation DES, maximum CK levels after primary PCI remain predictive of all-cause mortality and LV function, serving as an independent prognostic factor for long-term outcomes.

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