title: Usefulness of β-trace protein and cystatin C for the prediction of mortality in non ST segment elevation acute coronary syndromes.
abstract: Beta-trace protein (BTP) is a low-molecular mass protein belonging to the lipocalin protein family, which is more sensitive than serum creatinine for detecting impaired renal function. The aims of the present study were to evaluate whether plasma BTP improves the risk stratification of patients with non-ST-segment elevation acute coronary syndromes and to compare it to cystatin C (CysC), serum creatinine, and estimated glomerular filtration rate. Two hundred twenty-six consecutive patients with non-ST-segment elevation acute coronary syndromes were prospectively included. Blood samples were obtained within 24 hours of hospital admission to measure BTP, CysC, and creatinine. The study end point was all-cause death. Over a median follow-up period of 859 days (interquartile range [IQR] 524 to 1,164), 24 patients (10.6%) died. Decedents had higher concentrations of BTP (1.03 mg/L [IQR 0.89 to 1.43] vs 0.74 mg/L [IQR 0.61 to 0.92], p <0.001), CysC (1.16 mg/L [IQR 0.91 to 1.59] vs 0.90 mg/L [IQR 0.76 to 1.08], p = 0.001), and serum creatinine (1.10 mg/L [IQR 0.87 to 1.46] vs 0.94 mg/L [IQR 0.80 to 1.10], p = 0.004) and a lower mean estimated glomerular filtration rate (60 ± 20 vs 80 ± 24 ml/min/1.73 m(2), p <0.001). After multivariate adjustment, BTP and CysC were predictors of all-cause death, while estimated glomerular filtration rate and serum creatinine concentrations did not achieve statistical significance. In stratified analyses according to kidney function, elevated BTP and CysC were associated with a higher risk for all-cause death. Reclassification analyses showed that BTP and CysC added complementary information to Global Registry for Acute Coronary Events (GRACE) risk score. In conclusion, BTP and CysC levels were associated with all-cause death risk and modestly improved prognostic discrimination beyond the GRACE risk score in patients with non-ST segment elevation acute coronary syndromes.
authors: Division of Cardiology, University Hospital Virgen de la Arrixaca, Murcia, Spain. sergiosmf13@hotmail.com
authors: Sergio
authors: S
authors: Manzano-Fernández
authors: Angel
authors: A
authors: López-Cuenca
authors: James L
authors: JL
authors: Januzzi
authors: Soledad
authors: S
authors: Parra-Pallares
authors: Alicia
authors: A
authors: Mateo-Martínez
authors: Marianela
authors: M
authors: Sánchez-Martínez
authors: Patricio
authors: P
authors: Pérez-Berbel
authors: Esteban
authors: E
authors: Orenes-Piñero
authors: Ana I
authors: AI
authors: Romero-Aniorte
authors: Francisco
authors: F
authors: Avilés-Plaza
authors: Mariano
authors: M
authors: Valdés-Chavarri
authors: Francisco
authors: F
authors: Marín
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood* / Q000175:diagnosis / Q000401:mortality*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D002423:Cause of Death; D015331:Cohort Studies; D016001:Confidence Intervals; D003404:Creatinine / Q000097:blood; D055316:Cystatin C / Q000097:blood*; D018450:Disease Progression; D004562:Electrocardiography / Q000379:methods; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D019746:Intramolecular Oxidoreductases / Q000097:blood*; D053208:Kaplan-Meier Estimate; D054834:Lipocalins / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D012737:Sex Factors; D016019:Survival Analysis
chemical_list: D015415:Biomarkers; D055316:Cystatin C; D054834:Lipocalins; D003404:Creatinine; D019746:Intramolecular Oxidoreductases; C022466:prostaglandin R2 D-isomerase