title: Cystatin C and risk of mortality among patients undergoing percutaneous coronary intervention.
abstract: OBJECTIVE
  We tested the prognostic value of cystatin C in patients with documented coronary artery disease (CAD) who underwent percutaneous coronary artery intervention (PCI). We also tested the hypothesis that the incremental predictive value of cystatin C on all-cause mortality was superior to that of glomerular filtration rate (GFR) by the Modification of Diet in Renal Disease (MDRD) formula.
  
  
  RESULTS
  Included in the study were 2,757 patients (mean age 63 years, 77% men). Blood samples for cystatin C levels were collected immediately before PCI. During a median follow-up of two years, 114 patients died. In multivariable Cox analyses, after adjustment for several confounders, GFR (p=0.004) and cystatin C concentration (p<0.0001) were independent predictors of all-cause death. Cystatin C predicted all-cause death (c-statistic: 0.794) better than GFR estimate based on creatinine (c-statistic: 0.776, p=0.008 for comparison), and significantly reclassified 15% of patients into categories that reflected their actual likelihood of death more accurately (p=0.005). Adding cystatin C and GFR in the same multivariable survival model, only cystatin C level was a significant predictor of death.
  
  
  CONCLUSIONS
  This study presents for the first time the incremental predictive value of cystatin C over the creatinine-based MDRD formula on all-cause mortality for CAD patients undergoing PCI.
authors.affiliation: Azienda Ospedaliera ed Universitaria di Perugia, Perugia, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Angeli
authors.forename: Paolo
authors.initials: P
authors.lastname: Verdecchia
authors.forename: Stefano
authors.initials: S
authors.lastname: Savonitto
authors.forename: Gustavo
authors.initials: G
authors.lastname: Arraiz
authors.forename: Martina
authors.initials: M
authors.lastname: Zaninotto
authors.forename: Andrea
authors.initials: A
authors.lastname: Broccatelli
authors.forename: Chiara
authors.initials: C
authors.lastname: Cosma
authors.forename: Stefano
authors.initials: S
authors.lastname: De Servi
authors.forename: Federico
authors.initials: F
authors.lastname: Sabino
authors.forename: Carlo
authors.initials: C
authors.lastname: Briguori
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Ambrosio
authors.forename: Claudio
authors.initials: C
authors.lastname: Cavallini
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D000368:Aged; D060050:Angina, Stable / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D015415:Biomarkers / Q000097:blood; D003404:Creatinine / Q000097:blood; D055316:Cystatin C / Q000097:blood*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007558:Italy; D007674:Kidney Diseases / Q000097:blood* / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D015999:Multivariate Analysis; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality*; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; C525030:CST3 protein, human; D055316:Cystatin C; D003404:Creatinine