Predictive value of elevated cystatin C in patients undergoing primary angioplasty for ST-elevation myocardial infarction

Ozgur Akgul, Huseyin Uyarel, Mehmet Ergelen, Hamdi Pusuroglu, Mehmet Gul, Selahattin Turen, Umit Bulut, Omer Faruk Baycan, Ender Ozal, Mustafa Cetin, Aydın Yıldırım, Nevzat Uslu
Journal of Critical Care 2013, 28 (5): 882.e13-20

OBJECTIVES: The prognostic value of cystatin C (CysC) has been documented in patients with acute coronary syndrome without ST-segment elevation. However, its value in acute ST-segment elevation myocardial infarction (STEMI) remains unclear. The aim of this study was to evaluate the prognostic value of CysC in patients with STEMI undergoing primary percutaneous coronary intervention (PCI).

METHODS: We prospectively enrolled 475 consecutive STEMI patients (mean age 55.6±12.4 years, 380 male, 95 female) undergoing primary PCI. The study population was divided into tertiles based on admission CysC values. The high CysC group (n=159) was defined as a value in the third tertile (>1.12 mg/L), and the low CysC group (n=316) included those patients with a value in the lower two tertiles (≤1.12 mg/L). Clinical characteristics and in-hospital and one-month outcomes of primary PCI were analyzed.

RESULTS: The patients of the high CysC group were older (mean age 62.8±13.1 vs. 52.3±10.5, P<.001). Higher in-hospital and 1-month cardiovascular mortality rates were observed in the high CysC group (9.4% vs. 1.6%, P<.001 and 14.5% vs. 2.2%, P<.001, respectively). In Cox multivariate analysis; a high admission CysC value (>1.12 mg/L) was found to be a powerful independent predictor of one-month cardiovascular mortality (odds ratio, 5.3; 95% confidence interval, 1.25-22.38; P=.02).

CONCLUSIONS: These results suggest that a high admission CysC level was associated with increased in-hospital and one-month cardiovascular mortality in patients with STEMI undergoing primary PCI.

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