Time course changes of cystatin C and inflammatory and biochemical markers in non-ST-elevation acute coronary syndromes.
BACKGROUND
Serum cystatin C (Cys-C), a good marker of renal function, predicts prognosis in non-ST-elevation acute coronary syndromes (NSTE-ACS). However, no data are available on the time course of Cys-C values after discharge. In this study, Cys-C was measured during admission (ACS sample) and 6 weeks after discharge, and was correlated with troponin (c-TNT), high-sensitivity C-reactive protein (hsCRP), interleukin 6 (IL-6) and the N-terminal portion of the pro-brain natriuretic peptide (proBNP) peptide (NT-proBNP) in a highly selected homogeneous group of NSTE-ACS patients.


METHODS
In this prospective, multicentre study, patients with a first NSTE-ACS, single-vessel disease and successful percutaneous coronary interventions (PCIs) had their sera collected, aliquoted and stored at the enrolling site and then shipped for analysis to the clinical chemistry core laboratory.


RESULTS
Cys-C values slightly, but significantly, increased from the ACS samples to the 6-week samples. In contrast, hsCRP, NT-proBNP and IL-6 values significantly decreased from the ACS to the 6-week sample. Patients with elevated c-TNT levels had higher hsCRP, NT-proBNP and IL-6 values than patients with normal c-TNT levels in the ACS sample, whereas Cys-C levels were similar in patients with and without elevated c-TNT. Cys-C was highly correlated with estimated glomerular filtration rate in both the ACS and 6-week samples.


CONCLUSIONS
In contrast to inflammatory and biochemical stress markers, Cys-C is not affected by the occurrence of myocardial necrosis or by acute left-ventricular impairment, being a reliable marker of renal function during NSTE-ACS.
aCardiovascular Department, AO 'Ospedale Civile', Legnano bDivision of Cardiology, Manzoni Hospital, Lecco cDivision of Cardiology, Misericordia e Dolce Hospital, Prato dDivision of Cardiology, AO 'Villa Scassi', Genova eDivision of Cardiology, Ospedali Riuniti, Treviglio fCardiology Unit, Spedali Civili, Brescia gDivision of Cardiology, St Antonio Abate Hospital, Gallarate hDivision of Cardiology, Desio Hospital, Desio iDivision of Cardiology, Terni Hospital, Terni jLaboratory Unit, AO 'Ospedale Civile' di Legnano, Italy.
Stefano
S
De Servi
Giuseppe
G
Mariani
Luigi
L
Piatti
Mario
M
Leoncini
Paolo
P
Rubartelli
Antonio
A
Pitì
Salvatore
S
Curello
Francesco
F
Galdangelo
Pietro
P
Vandoni
Enrico
E
Rossetti
Matteo
M
Mariani
Enrico
E
Boschetti
Gianpietro
G
Re
Milvia
M
Loznicker
D054058:Acute Coronary Syndrome / Q000097:blood* / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D055316:Cystatin C / Q000097:blood*; D005260:Female; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood*; D015850:Interleukin-6 / Q000097:blood; D007558:Italy; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D009206:Myocardium / Q000378:metabolism / Q000473:pathology; D020097:Natriuretic Peptide, Brain / Q000097:blood; D009336:Necrosis; D010343:Patient Admission; D010351:Patient Discharge; D010446:Peptide Fragments / Q000097:blood; D062645:Percutaneous Coronary Intervention; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014336:Troponin / Q000097:blood; D016277:Ventricular Function, Left
D015415:Biomarkers; C525030:CST3 protein, human; D055316:Cystatin C; C508600:IL6 protein, human; D018836:Inflammation Mediators; D015850:Interleukin-6; D010446:Peptide Fragments; D014336:Troponin; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D002097:C-Reactive Protein