Key result
Admission serum cystatin C > 1.30 mg/L independently predicted in-hospital mortality (OR 3.85) in patients with ST-elevation myocardial infarction treated by primary percutaneous coronary intervention.
Why the study?
Does admission cystatin C predict in-hospital mortality and MACE in patients with STEMI treated by primary PCI?
Observational (n=659)
No
Does admission cystatin C predict in-hospital mortality and MACE in patients with STEMI treated by primary PCI?
Admission cystatin C is a strong, independent predictor of early in-hospital mortality in patients with STEMI undergoing primary PCI, performing comparably to the GRACE score.
Ăvod: Cystatin C je povaĹžovĂĄn za prognostickĂ˝ marker kardiovaskulĂĄrnĂch onemocnÄnĂ. CĂlem tĂŠto prospektivnĂ prĂĄce bylo zhodnotit pĹĂnos hodnocenĂ cystatinu C v prognostickĂŠ stratifikaci k predikci nemocniÄnĂ mortality a zĂĄvaĹžnĂ˝ch neŞådoucĂch kardiĂĄlnĂch pĹĂhod (major cardiac adverse events, MACE) u pacientĹŻ s infarktem myokardu s elevacemi Ăşseku ST (STEMI) a porovnat vĂ˝znam cystatinu C s dalĹĄĂmi ukazateli renĂĄlnĂch funkcĂ a skĂłre GRACE (Global Registry of Acute Coronary Events).Metody: Do prospektivnĂ studie bylo zaĹazeno 659 konsekutivnĂch pacientĹŻ (479 muŞů, prĹŻmÄrnĂ˝ vÄk 65 let) s akutnĂm infarktem myokardu s elevacemi Ăşseku ST lĂŠÄenĂ˝ch primĂĄrnĂ perkutĂĄnnĂ koronĂĄrnĂ intervencĂ (PCI). PĹi pĹijetĂ byl proveden standardnĂ laboratornĂ odbÄr zahrnujĂcĂ cystatin C, troponin T, N-terminĂĄlnĂ fragment natriuretickĂŠho propeptidu typu B (NT-proBNP), dalĹĄĂ biomarkery renĂĄlnĂch funkcĂ. Schopnost cystatinu C, dalĹĄĂch biomarkerĹŻ a skĂłre GRACE predikovat nemocniÄnĂ mortalitu a MACE (rekurence akutnĂho koronĂĄrnĂho syndromu, iktus, in-stent trombĂłza, mortalita) byla hodnocena pomocĂ c-statistiky.VĂ˝sledky: NemocniÄnĂ mortalita dosĂĄhla 4 % (n = 26), vĂ˝skyt MACE pak 6,8 % (n = 45). VstupnĂ hodnota cystatinu C, kreatininu, urey, glomerulĂĄrnĂ filtrace, troponinu T, NT-proBNP a GRACE byla shledĂĄna jako nezĂĄvislĂ˝ prognostickĂ˝ faktor.SĂŠrovĂĄ koncentrace cystatinu C a hodnota skĂłre GRACE byla signifikantnÄ vyĹĄĹĄĂ u zemĹelĂ˝ch (1,65 ± 0,91 vs. 0,97 ± 0,41 mg/ml; p < 0,001, resp. 138 ± 43 vs. 99 ± 31; p < 0,001). Hodnota plochy pod kĹivkou (area under the curve, AUC) pro predikci mortality a MACE pro cystatin C a skĂłre GRACE byla 0,83 a 0,88, respektive 0,66 a 0,72 (vĹĄe p < 0,001) s optimĂĄlnĂ hraniÄnĂ hodnotou 1,3 mg/ml pro cystatin C a 136 pro skĂłre GRACE.Hodnota cystatinu C nad mez 1,30 mg/l byla asociovĂĄna s nejvyĹĄĹĄĂm adjustovanĂ˝m pomÄrem ĹĄancĂ (odds ratio, OR) 3,85 (95% interval spolehlivosti 2,36-6,38; p < 0,001) pro nemocniÄnĂ mortalitu (senzitivita 77 %, specificita 86 %). Kombinace cystatinu C a skĂłre GRACE nevedla k dalĹĄĂmu signifikantnĂmu zlepĹĄenĂ rizikovĂŠ stratifikace (OR 1,05; 95% interval spolehlivosti 1,04-1,07; p < 0,001).ZĂĄvÄr: Cystatin C byl potvrzen jako prediktor ÄasnĂŠho vĂ˝sledku srovnatelnĂ˝ se skĂłre GRACE u pacientĹŻ se STEMI.
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Přeček et al. (2017) conducted an observational in ST elevation myocardial infarction (STEMI) (n=659). Elevated Cystatin C (> 1.30 mg/L) vs. Cystatin C ≤ 1.30 mg/L was evaluated on In-hospital mortality (OR 3.85, 95% CI 2.36-6.38, p=<0.001). Admission serum cystatin C > 1.30 mg/L independently predicted in-hospital mortality (OR 3.85) in patients with ST-elevation myocardial infarction treated by primary percutaneous coronary intervention.
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