Plasma cystatin C for prediction of 1-year cardiac events in Mediterranean patients with non-ST elevation acute coronary syndrome
Introduction
Chronic kidney disease (CKD) represents an important public health problem worldwide with an estimated prevalence of 13% in the Western world [1], [2]. CKD patients are at an increased risk of developing cardiovascular disease (CVD) and serious CV events compared to subjects with normal renal function (RF) [2], [3], [4], [5], [6]. Cystatin C, a marker of RF, is particularly useful for the estimation of small reductions in glomerular filtration rate (GFR) [7], [8], [9] and has been also proposed to represent a marker of cardiovascular risk [10], [11], [12], [13].
Risk stratification plays a crucial role in the management of patients with non-ST elevation acute coronary syndrome (NSTE-ACS) and it has been shown that risk stratification score systems that incorporate markers of RF perform better than score systems without RF markers [14], [15].
Few studies to date have evaluated specifically the prognostic role of cystatin C in patients with NSTE-ACS. Of these, only one study carried out in patients recruited over 10 years ago, focused exclusively on NSTE-ACS patients [16]. Moreover, the prognostic role of cystatin C has not been evaluated in Mediterranean patients with ACS, who in epidemiological studies appear to have lower cardiovascular mortality rates [17].
We therefore sought to assess prospectively the prognostic value of cystatin C in Spanish patients with established NSTE-ACS receiving treatment in accordance to current guidelines.
Section snippets
Patients
Five hundred and twenty-five (86%) of 610 patients enrolled in the multicentre SIESTA (systemic inflammation evaluation in patients with NSTE-ACS) study were assessed. Eighty-five (14%) patients in whom we lacked complete information on creatinine and/or cystatin C data were excluded from analysis. The two groups were similar in terms of baseline clinical, procedural and laboratory characteristics. However, there were less smokers (15.5% vs. 28.2%; p = 0.019) and less people with BMI > 30 (16.5%
Results
Baseline demographics, clinical, procedural and biochemical data in the study patients are listed in Table 1. Of the patients recruited, 329 (63%) had NSTEMI and 196 (37%) unstable angina. One hundred and thirty-five (26%) patients were women. Patients in the highest cystatin C quartile were older and showed a higher prevalence of diabetes and hypertension. They also had a higher TIMI risk score, increased BMI values and higher CRP concentrations. Cystatin C concentrations correlated with age (r
Discussion
The present prospective study showed, for the first time, that increased cystatin C levels were an independent predictor of cardiac events in a contemporary series of Mediterranean patients with confirmed NSTE-ACS. Our results thus confirm and expand the predictive role of cystatin C in ischemic heart disease patients, as suggested by other investigators [16], [23], [24], [25]. Moreover, our study supports the existence of a threshold effect for cystatin C. These findings are consistent with
Conclusions
Our study showed that cystatin C is an independent predictor of 1-year cardiac events in Mediterranean patients with NSTE-ACS. The potential clinical usefulness of this molecule as a clinical marker of cardiovascular risk, as suggested by our data, requires further confirmation in larger studies. Moreover, studies are also needed to elucidate the true pathogenic link between increased cystatin C levels and the development of further serious atherosclerotic cardiovascular events in patients with
Conflict of interest
None declared.
Acknowledgments
We are grateful to Mrs Gerlinde Trischler for excellent technical assistance. Reagents for measurement of cystatin C were a gift from Dade-Behring, Germany.
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- 1
The SIESTA study was supported by unrestricted grants from Bristol Myers Squibb (Madrid, Spain), and the Spanish Society of Cardiology.
- 2
Daniel J. Fernández-Bergés was supported by the Ministerio de Sanidad y Consumo, Instituto de Salud Carlos III and fundesalud (Grupo emergente GRIMEX).
- 3
Luciano Consuegra Sánchez was supported by grants by the Spanish Society of Cardiology and Fundación de Investigación del Hospital Clínico de Valencia.
- 4
N. Taglieri is sponsored by a scholarship from Institute of Cardiology, St. Orsola-Malpighi Hospital, Bologna University, Bologna, Italy.