Plasma cystatin C for prediction of 1-year cardiac events in Mediterranean patients with non-ST elevation acute coronary syndrome.
OBJECTIVE
Evaluation of renal function (RF) is important for management of patients with non-ST elevation acute coronary syndrome (NSTE-ACS). Cystatin C, a sensitive marker of RF, appears to be also a marker of cardiovascular risk. Little is known regarding its predictive role in NSTE-ACS patients.


METHODS
We assessed 525 patients taking part in the "Systemic Inflammation Evaluation in patients with NSTE-ACS" (SIESTA) study. Patients were subdivided in quartiles according to cystatin C plasma concentrations (mg/L), i.e., Q1<0.81; Q2=0.81-0.92; Q3=0.93-1.10; Q4>or=1.11. Glomerular filtration rate (eGFR) was estimated using the modification of diet in renal disease (MDRD) equation. The study end-point was the composite of cardiac death, non-fatal myocardial infarction and unstable angina at 1-year follow up.


RESULTS
Few patients (0.8%) had severely impaired RF (MDRD<30ml/min/1.73m(2)). 157 patients reached (30%) the study end-point. Patients in Q3 and Q4 showed a higher cumulative probability of cardiac events compared to patients in the lowest quartile. On multivariable analysis, patients in Q3 and Q4 had an increased incidence of cardiac events (adjusted HR=1.57 95%CI 1.04-2.49; p=0.036). Patients with TIMI risk score >or=3 or in-hospital heart failure were also at higher risk for acute cardiac events. Conventional markers of RF, i.e., serum creatinine and eGRF, were not predictors for the study end-point.


CONCLUSIONS
Increased levels of cystatin C were an independent predictor of cardiac events at 1-year follow up in this contemporary series of Mediterranean patients with NSTE-ACS.
Taglieri
Nevio
N
Cardiovascular Biology Research Centre, Division of Cardiac and Vascular Sciences, St. George's University of London, London, UK.
Fernandez-Berges
Daniel J
DJ
Koenig
Wolfgang
W
Consuegra-Sanchez
Luciano
L
Fernandez
José Maria Cruz
JM
Robles
Nicolas Roberto
NR
Sánchez
Pedro Luis
PL
Beiras
Alfonso Castro
AC
Orbe
Pedro Maria Montes
PM
Kaski
Juan Carlos
JC
D054058:Acute Coronary Syndrome / Q000097:blood / Q000401:mortality*; D000368:Aged; D000789:Angina, Unstable / Q000097:blood / Q000401:mortality*; D055316:Cystatin C / Q000097:blood*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D008297:Male; D019083:Mediterranean Region; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000401:mortality*; D011379:Prognosis; D013030:Spain / Q000453:epidemiology
D055316:Cystatin C