High cystatin C levels predict long-term mortality in patients with ST-segment elevation myocardial infraction undergoing late percutaneous coronary intervention: a retrospective study.

OBJECTIVES: Late percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infraction (STEMI), defined as time of PCI > 7 days from symptom onset, is a common practice with clinical benefits. This study aimed to evaluate the predictive value of admission cystatin C level on long-term mortality in STEMI patients receiving late PCI.

METHODS: Medical records of STEMI patients who were hospitalized between 2009 and 2011 from eight PCI-capable hospitals in Northwest China were retrospectively analyzed. Cystatin C level ≥1.105 mg/L was considered as the best predictor of long-term mortality based on the receiver-operating characteristic analysis. Patients were followed up by phone or face-to-face interviews, and the long-term mortality was obtained by reviewing medical records.

RESULTS: The final analysis included 716 STEMI patients who received late PCI and had available cystatin C levels prior to PCI , and 524 were assigned into the high cystatin C group and 192 the low cystatin C group. Patient were followed up for an average length of 40.37 months. Compared with the low cystatin C group, the high cystatin C group had a higher long-term all-cause mortality (10.4% vs. 2.9%, P < 0.001) and a higher cardiac mortality (6.8% vs. 2.1%, P=0.004). Multivariate Cox regression analysis showed that high cystatin C level was an independent predictor for both long-term all-cause mortality and cardiac mortality.

CONCLUSIONS: High cystatin C level at admission is an independent predictor of long-term mortality in STEMI patients undergoing late PCI.