ObjectiveTo analyze the influencing and prognostic factors for in-hospital death of creatine kinase-MB after cardiac surgery for congenital heart disease in pediatric. MethodsClinical data of 708 children with body weight less than 15 kg who underwent cardiac surgery at Fu Wai Hospital between January 2012 and December 2013 were retrospectively analyzed. There were 269 males (38.0%) and 439 females (62.0%). The postoperative maximum CK-MB was calculated for analysis and patients were devided into three groups:a group A (CK-MB≤25 IU/L), a group B (25 IU/L < CK-MB≤125 IU/L) and a group C (CK-MB > 125 IU/L). ResultsPostoperative CK-MB level was independently associated with cyanotic congenital heart disease (P=0.002), the aorta cross clamp (P=0.030), the cardiopulmonary bypass time (P=0.002), the cross clamp time (P=0.016), the re-establish of bypass (P < 0.001), deep hypothermic circulatory arrest (P=0.024). There was statistical difference in mortality between the 3 groups (P < 0.001). The receiver operating characteristic curve showed that CK-MB has predictive value for in-hospital death (P < 0.001) and the cutoff value is 168.5 IU/L, with a sensitivity of 54.2%, specificity of 90.8%, positive predictive value of 17.3% and negative predictive value of 98.4%. CK-MB level above 168.5 IU/L was an independent risk factor for in-hospital death (OR=6.364, P < 0.001). ConclusionElevation of CK-MB after cardiac surgery is independently influenced by several variables. Pediatric with major CK-MB elevation has high risk of in-hospital death.