title: Cystatin C as prognostic biomarker in ST-segment elevation acute myocardial infarction.
abstract: Cystatin C is a marker of renal dysfunction, and preliminary studies have suggested it might have a role as a prognostic marker in patients with coronary artery disease. The aim of the present study was to evaluate the usefulness of cystatin C for risk stratification of patients with ST-segment elevation myocardial infarction, regarding in-hospital and long-term outcomes. We included 153 consecutive patients with ST-segment elevation myocardial infarction treated by primary angioplasty. The baseline cystatin C level was measured at coronary angiography. The in-hospital outcome was determined as progression to cardiogenic shock or in-hospital death, and the long-term outcome was assessed, considering the following end points: (1) death and (2) death or reinfarction. Of the 153 patients evaluated (age 61 ± 12 years; 75.6% men), 15 (14.4%) progressed to cardiogenic shock and 4 (2.7%) died during hospitalization. The patients who progressed to cardiogenic shock or died during hospitalization had significantly greater cystatin C levels (1.02 ± 0.44 vs 0.69 ± 0.24 mg/L; p = 0.001). Long-term follow-up was available for 130 patients (583 ± 163 days). Among them, 11 patients died and 7 had reinfarction. A high baseline cystatin C level was associated with an increased risk of death (hazard ratio 8.5; p = 0.009) and death or reinfarction (hazard ratio 3.89; p = 0.021). Furthermore, only high baseline cystatin C levels and left ventricular ejection fraction ≤40% were independent predictors of the long-term risk of death, with synergistic interaction between the 2. In conclusion, cystatin C is a new biomarker with significant added prognostic value for patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention, predicting both short- and long-term outcomes.
authors.affiliation: Cardiology Department, Santa Maria University Hospital, Lisbon North Hospital Centre, Portugal. dojreis@hotmail.com
authors.forename: Doroteia
authors.initials: D
authors.lastname: Silva
authors.forename: Nuno
authors.initials: N
authors.lastname: Cortez-Dias
authors.forename: Cláudia
authors.initials: C
authors.lastname: Jorge
authors.forename: J Silva
authors.initials: JS
authors.lastname: Marques
authors.forename: Pedro
authors.initials: P
authors.lastname: Carrilho-Ferreira
authors.forename: Andreia
authors.initials: A
authors.lastname: Magalhães
authors.forename: Susana R
authors.initials: SR
authors.lastname: Martins
authors.forename: Susana
authors.initials: S
authors.lastname: Gonçalves
authors.forename: Pedro Canas
authors.initials: PC
authors.lastname: da Silva
authors.forename: Manuela
authors.initials: M
authors.lastname: Fiúza
authors.forename: António Nunes
authors.initials: AN
authors.lastname: Diogo
authors.forename: Fausto J
authors.initials: FJ
authors.lastname: Pinto
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D015415:Biomarkers / Q000097:blood*; D017023:Coronary Angiography; D055316:Cystatin C / Q000097:blood*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000175:diagnosis / Q000628:therapy; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers; D055316:Cystatin C