title: Cystatin C and estimated glomerular filtration rate as predictors for adverse outcome in patients with ST-elevation and non-ST-elevation acute coronary syndromes: results from the Platelet Inhibition and Patient Outcomes study.
abstract: BACKGROUND
  We evaluated the predictive ability of cystatin C and creatinine-based estimations of glomerular filtration rate (eGFR), including the Chronic Kidney Disease-Epidemiology (CKD-EPI) equation, in acute coronary syndrome (ACS) patients with (STE-ACS) or without (NSTE-ACS) ST elevation in a large contemporary ACS population.
  
  
  METHODS
  Concentrations of cystatin C and creatinine, as well as eGFR at randomization, were measured in 16 401 patients in the Platelet Inhibition and Patient Outcomes (PLATO) study and evaluated as predictors of the composite end point of cardiovascular death or myocardial infarction within 1 year. Two Cox proportional hazards models were used, the first adjusting for clinical characteristics and the second for clinical characteristics plus the biomarkers N-terminal pro-B-type natriuretic peptide, troponin I, and C-reactive protein.
  
  
  RESULTS
  The median cystatin C value was 0.83 mg/L. Increasing quartiles of cystatin C were strongly associated with poor outcome (6.9%, 7.1%, 9.5%, and 16.2%). The fully adjusted hazard ratios per SD of cystatin C in the NSTE-ACS and STE-ACS populations were 1.12 (95% CI 1.04-1.20) (n=8053) and 1.06 (95% CI 0.97-1.17) (n=5278), respectively. There was no significant relationship of cystatin C with type of ACS (STE or NSTE). c Statistics ranged from 0.6923 (cystatin C) to 0.6941 (CKD-EPI).
  
  
  CONCLUSIONS
  Cystatin C concentration contributes independently in predicting the risk of cardiovascular death or myocardial infarction in NSTE-ACS, with no interaction by type of ACS. CKD-EPI exhibited the largest predictive value of all renal markers. Nevertheless, the additive predictive value of cystatin C or creatinine-based eGFR measures in the unselected ACS patient is small.
authors: Department of Medical Sciences, Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden. axel.akerblom@ucr.uu.se
authors: Åxel
authors: Å
authors: Akerblom
authors: Lars
authors: L
authors: Wallentin
authors: Agneta
authors: A
authors: Siegbahn
authors: Richard C
authors: RC
authors: Becker
authors: Andrzej
authors: A
authors: Budaj
authors: Kristen
authors: K
authors: Buck
authors: Evangelos
authors: E
authors: Giannitsis
authors: Jay
authors: J
authors: Horrow
authors: Steen
authors: S
authors: Husted
authors: Hugo A
authors: HA
authors: Katus
authors: Philippe Gabriel
authors: PG
authors: Steg
authors: Robert F
authors: RF
authors: Storey
authors: Nils
authors: N
authors: Åsenblad
authors: Stefan K
authors: SK
authors: James
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis* / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D000241:Adenosine / Q000031:analogs & derivatives / Q000627:therapeutic use; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D000077144:Clopidogrel; D003404:Creatinine / Q000097:blood; D055316:Cystatin C / Q000097:blood*; D004311:Double-Blind Method; D023381:Endpoint Determination; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011498:Protein Precursors / Q000097:blood; D000077486:Ticagrelor; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D019210:Troponin I / Q000097:blood
chemical_list: D015415:Biomarkers; D055316:Cystatin C; D010446:Peptide Fragments; D010975:Platelet Aggregation Inhibitors; D011498:Protein Precursors; D019210:Troponin I; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D002097:C-Reactive Protein; D000077144:Clopidogrel; D003404:Creatinine; D000077486:Ticagrelor; D000241:Adenosine; D013988:Ticlopidine