Comparison of the long-term prognostic value of cystatin C to other indicators of renal function, markers of inflammation and systolic dysfunction among patients with acute coronary syndrome.
OBJECTIVE
Emerging evidence indicates the prognostic importance of cystatin C (Cys-C) in patients with coronary artery disease. However, whether Cys-C concentrations are associated with adverse clinical events among patients with acute coronary syndromes (ACS) have not been studied extensively. We compared the long-term prognostic efficacy of Cys-C with other markers of renal dysfunction, inflammation and systolic dysfunction in patients with ACS.


RESULTS
Serum levels of Cys-C, high sensitive C-reactive protein (hs-CRP), brain natriuretic peptide (BNP) and creatinine were measured in 160 patients with ACS (112 males, 48 females, mean age 60+/-10 years) on admission. Primary end point of the study was major adverse cardiac events (MACE) defined as the combination of cardiac death, non-fatal myocardial infarction and recurrent rest angina that required hospitalization within 12 months of follow-up. During the follow-up period, 42 (26%) patients met the MACE criteria. The occurrence of MACE was significantly higher among patients with higher Cys-C levels. In multivariate analysis, Cys-C was the most important parameter associated with the occurrence of MACE (OR=9.62, 95% CI=2.3-40.5, p<0.001). ROC curve analysis showed that the predictive cut-off value of Cys-C for MACE was 1051ng/ml. In the Cox regression analysis adjusted for multiple risk factors, Cys-C was found as the most powerful predictor for MACE (RR=9.43, 95% CI=4.0-21.8, p<0.001).


CONCLUSIONS
The results of the present study indicate that admission levels of Cys-C may be a good prognostic indicator of recurrent cardiovascular events in patients with ACS. Further studies are needed to confirm these results.
Kilic
Teoman
T
Kocaeli University Medical Faculty, Department of Cardiology, Invasive Cardiology Research and Application Unit, Kocaeli, Turkey. teoman.kilic@kocaeli.edu.tr
Oner
Gokhan
G
Ural
Ertan
E
Yumuk
Zeki
Z
Sahin
Tayfun
T
Bildirici
Ulas
U
Acar
Eser
E
Celikyurt
Umut
U
Kozdag
Guliz
G
Ural
Dilek
D
D054058:Acute Coronary Syndrome / Q000097:blood* / Q000150:complications / Q000401:mortality / Q000503:physiopathology; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000097:blood / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D003404:Creatinine / Q000097:blood; D055316:Cystatin C / Q000097:blood*; D005260:Female; D006801:Humans; D007249:Inflammation / Q000097:blood* / Q000150:complications / Q000401:mortality / Q000503:physiopathology; D018836:Inflammation Mediators / Q000097:blood*; D053208:Kaplan-Meier Estimate; D007674:Kidney Diseases / Q000097:blood* / Q000150:complications / Q000401:mortality / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012372:ROC Curve; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D013599:Systole; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000097:blood* / Q000150:complications / Q000401:mortality / Q000503:physiopathology
D015415:Biomarkers; C525030:CST3 protein, human; D055316:Cystatin C; D018836:Inflammation Mediators; D020097:Natriuretic Peptide, Brain; D002097:C-Reactive Protein; D003404:Creatinine