title: Long-term prognostic impact of cystatin C on acute coronary syndrome octogenarians with diabetes mellitus.
abstract: OBJECTIVE
  Cystatin C (Cys C) is a marker of renal dysfunction. Prior studies have shown that blood Cys C is related to the prognosis of coronary heart disease. The aim of the present study was to evaluate the long-term prognostic impact of Cys C on acute coronary syndrome (ACS) octogenarians with diabetes mellitus (DM).
  
  
  METHODS
  We enrolled 660 consecutive ACS octogenarians who underwent coronary angiography and were classified into two groups based on diabetes. The baseline characters and Cys C level were measured on admission. Survival curve was calculated using the Kaplan-Meier method. Multivariate Cox regression was used to identify predictors of mortality and of major adverse cardiac events (MACE) rate.
  
  
  RESULTS
  There were 223 and 398 patients in groups DM and non-DM who fulfilled the follow-up. The average follow-up period was 28 (IQR 16-38) months. Diastolic blood pressure (DBP) was lower, ratios of hypertension and chronic renal failure (CRF), fasting blood glucose, HbA1c and Cys C levels were higher in DM group than those in non-DM group (P<0.01). The cumulative survival of DM group was significantly lower than that of non-DM group in the long term (P = 0.018). All cause mortality and MACE of DM group were higher than those of non-DM group (P<0.05). The plasma Cys C concentration (OR = 3.32, 95% CI = 1.18-10.92, P = 0.023) was the uniqueness independent predictor for long-term all cause mortality. The plasma Cys C concentration (OR = 2.47, 95% CI = 1.07-7.86, P = 0.029) and Genesis score (OR = 1.01, 95% CI = 1.00-1.03, P = 0.043) were independent predictors for MACE in DM group. ROC curve analysis showed that the predictive cut-off value of Cys C for mortality of DM group was 1.605 (0.718, 0.704).
  
  
  CONCLUSIONS
  Cys C is an independent predictor for long-term mortality and MACE of ACS octogenarians with DM.
authors.forename: Zhenhong
authors.initials: Z
authors.lastname: Fu
authors.forename: Hao
authors.initials: H
authors.lastname: Xue
authors.forename: Jun
authors.initials: J
authors.lastname: Guo
authors.forename: Lian
authors.initials: L
authors.lastname: Chen
authors.forename: Wei
authors.initials: W
authors.lastname: Dong
authors.forename: Luyue
authors.initials: L
authors.lastname: Gai
authors.forename: Hongbin
authors.initials: H
authors.lastname: Liu
authors.forename: Zhijun
authors.initials: Z
authors.lastname: Sun
authors.affiliation: Department of Cardiology, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Beijing, Haidian District 100853, People's Republic of China. chenyundai301@gmail.com.
authors.forename: Yundai
authors.initials: Y
authors.lastname: Chen
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood* / Q000150:complications / Q000401:mortality; D000369:Aged, 80 and over; D000789:Angina, Unstable / Q000097:blood* / Q000150:complications / Q000401:mortality; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D015331:Cohort Studies; D017023:Coronary Angiography; D055316:Cystatin C / Q000097:blood*; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000097:blood* / Q000401:mortality; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000097:blood* / Q000150:complications / Q000401:mortality; D011379:Prognosis; D016016:Proportional Hazards Models; D012372:ROC Curve; D051436:Renal Insufficiency, Chronic / Q000097:blood* / Q000150:complications
chemical_list: D015415:Biomarkers; C525030:CST3 protein, human; D055316:Cystatin C