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Chen J, Yang Y, Dai C, Wang Y, Zeng R, Liu Q. Serum cystatin C is associated with the prognosis in acute myocardial infarction patients after coronary revascularization: a systematic review and meta-analysis. BMC Cardiovasc Disord 2022; 22:156. [PMID: 35392813 PMCID: PMC8991719 DOI: 10.1186/s12872-022-02599-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 03/25/2022] [Indexed: 12/31/2022] Open
Abstract
Objective Our study aimed to assess the association between serum cystatin C levels and prognosis in acute myocardial infarction (AMI) patients after coronary reconstructive surgery. Methods We searched PubMed, Embase, and Cochrane Library up to January 21, 2022 without language restriction. Outcomes were major cardiovascular events (MACEs) and mortality. The risk ratio (RR) and 95% confidence interval (CI) were merged by random-effect models. Results We included 8 studies with a total of 7,394 subjects in our meta-analysis. Our meta-analysis showed that higher-level of serum cystatin C levels were associated with higher risk of MACEs (RR = 2.52, 95% CI 1.63–3.89, P < 0.001) and mortality (RR = 2.64, 95% CI 1.66–4.19, P < 0.001) in AMI patients after coronary revascularization. Subgroup analysis showed that the serum cystatin C levels were associated with significantly higher risk of MACEs (RR = 2.72, 95% CI 1.32–5.60, P = 0.006) and mortality (RR = 2.98, 95% CI 1.21–7.37, P = 0.020) in AMI patients after percutaneous coronary intervention (PCI). However, in AMI patients after coronary artery bypass surgery, there were no significantly higher risk of MACEs (RR = 2.41, 95% CI 0.98–5.93, P = 0.05) and mortality (RR = 3.15, 95% CI 0.76–13.03, P = 0.10). Further subgroup analysis showed that this significantly higher risk of MACEs and mortality did not change with the study sample size, study population area or study follow-up time. Conclusion The meta-analysis demonstrated that higher serum cystatin C levels were associated with significantly higher risk of MACEs and mortality in AMI patients after PCI. It is a biomarker for risk stratification for predicting the prognosis in AMI patients after PCI. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-022-02599-5.
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Affiliation(s)
- Jun Chen
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, 310000, Zhejiang, China
| | - Yang Yang
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, 310000, Zhejiang, China
| | - Chuxing Dai
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, 310000, Zhejiang, China
| | - Yimin Wang
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, 310000, Zhejiang, China
| | - Rui Zeng
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, 310000, Zhejiang, China
| | - Qiang Liu
- The Third Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou, 310000, Zhejiang, China. .,The First School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, 310000, Zhejiang, China.
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Long M, Li L. Serum Levels of Cystatin C, N-Terminal Pro-B-Type Natriuretic Peptide (NT-proBNP), and Cardiac Function in Patients with Unstable Angina Pectoris. MEDICAL SCIENCE MONITOR : INTERNATIONAL MEDICAL JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2020; 26:e920721. [PMID: 32165608 PMCID: PMC7092660 DOI: 10.12659/msm.920721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background This study aimed to investigate the association between serum levels of cystatin C, N-terminal pro-B-type natriuretic peptide (NT-proBNP), and cardiac function in patients with unstable angina pectoris (UAP). Material/Methods A cross-sectional observational study was conducted at a single center and recruited 300 patients (214 men and 86 women), who were diagnosed with UAP between June 2018 to December 2018. The patients had serum levels of NT-ProBNP measured and were divided into four groups according to the serum levels of cystatin C: Q1, 0.49–0.83 mg/L; Q2, 0.84–1.04 mg/L; Q3, 1.05–1.38 mg/L; Q4, 1.39–4.21 mg/L. Cardiac function was graded according to the New York Heart Association (NYHA) class I to IV criteria. Results In the 300 patients with UAP, there were significant differences in cardiac function and NT-ProBNP levels between the four study groups (Q1 to Q4) (p<0.05). Univariate analysis showed that body weight, heart rate, treatment with aspirin, ticagrelor, angiotensin-converting enzyme inhibitor and an angiotensin receptor blocker (ACE/ARB), diuretic use, uric acid level, and serum cystatin C levels were significantly associated with increased levels of NT-ProBNP. After adjusting for confounding factors screened in univariate analysis, multivariate regression analysis showed that increased serum cystatin C levels were significantly associated with increased levels of NT-ProBNP. Conclusions Increased serum levels of cystatin C were associated with poor cardiac function and increased levels of NT-ProBNP in patients with UAP.
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Affiliation(s)
- Manyun Long
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China (mainland)
| | - Lang Li
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China (mainland)
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Wang XY, Zhang F, Zhang C, Zheng LR, Yang J. The Biomarkers for Acute Myocardial Infarction and Heart Failure. BIOMED RESEARCH INTERNATIONAL 2020; 2020:2018035. [PMID: 32016113 PMCID: PMC6988690 DOI: 10.1155/2020/2018035] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 11/05/2019] [Accepted: 12/04/2019] [Indexed: 01/06/2023]
Abstract
The use of a large number of cardiovascular biomarkers, meant to complement the use of the electrocardiogram, echocardiography cardiac imaging, and clinical symptom assessment, has become a routine in clinical diagnosis, differential diagnosis, risk stratification, and prognosis and guides the management of patients with suspected cardiovascular diseases. There is a broad consensus that cardiac troponin and natriuretic peptides are the preferred biomarkers in clinical practice for the diagnosis of the acute coronary syndrome and heart failure, respectively, while the roles and possible clinical applications of several other potential biomarkers are still under study. This review mainly focuses on the recent studies of the roles and clinical applications of troponin and natriuretic peptides, which seem to be the best-validated markers in distinguishing and predicting the future cardiac events of patients with suspected cardiovascular diseases. Additionally, the review briefly discusses some of the large number of potential markers that may play a more prominent role in the future.
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Affiliation(s)
- Xi-Ying Wang
- Department of Cardiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Fen Zhang
- Department of Cardiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Chi Zhang
- Department of Cardiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Liang-Rong Zheng
- Department of Cardiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Jian Yang
- Department of Cardiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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Serum cystatin C levels relate to no-reflow phenomenon in percutaneous coronary interventions in ST-segment elevation myocardial infarction. PLoS One 2019; 14:e0220654. [PMID: 31369621 PMCID: PMC6675089 DOI: 10.1371/journal.pone.0220654] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 07/19/2019] [Indexed: 12/19/2022] Open
Abstract
Background/Aim No-reflow is a serious and frequent event during primary percutaneous coronary intervention (PPCI) for acute ST segment elevation myocardial infarction (STEMI). The aim of this study was to identify possible predictors for no-reflow. Patients and methods We investigated 218 patients with acute anterior STEMI who underwent PPCI from December 2016 to December 2018. No-reflow was defined as a coronary TIMI flow grade of ≤ 2. TIMI flow grade 3 was defined as normal reflow. Results In our study, the no-reflow phenomenon was observed in 39 patients (18%) during angiography. The patients of no-reflow group were found to be more older, diabetics, longer pain-to-balloon time, lower blood pressure, higher platelet counts and higher levels of D-Dimer and Cystatin C (Cys-C). In multivariate logistic regression analysis, only diabetes (OR = 0.371, 95% CI: 0.157–0.872, P = 0.023), longer pain-to-balloon time (OR = 1.147, 95% CI: 1.015–1.297, P = 0.028) and higher Cys-C level (OR = 10.07, 95% CI: 2.340–43.377, P = 0.002) were predictors for no-reflow. Conclusion Cys-C might be a useful predictor for the no-reflow phenomenon after PPCI in STEMI patients. It might help to screen STEMI patients with high risk of no-reflow on admission.
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Chen Y, Fan Y, Men M, Shen G, Ma A. High cystatin C levels predict long-term mortality in patients with ST-segment elevation myocardial infarction undergoing late percutaneous coronary intervention: A retrospective study. Clin Cardiol 2019; 42:572-578. [PMID: 30907012 PMCID: PMC6523002 DOI: 10.1002/clc.23179] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 03/16/2019] [Accepted: 03/22/2019] [Indexed: 11/07/2022] Open
Abstract
Objectives Late percutaneous coronary intervention (PCI) in patients with ST‐segment elevation myocardial infarction (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 (cys 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. Cys 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 cys C levels prior to PCI, and 524 were assigned into the high cys C group and 192 the low cys C group. Patients were followed up for an average length of 40.37 months. Compared with the low cys C group, the high cys 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 cys C level was an independent predictor for both long‐term all‐cause mortality and cardiac mortality. Conclusions High cys C level at admission is an independent predictor of long‐term mortality in STEMI patients undergoing late PCI.
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Affiliation(s)
- Yuewu Chen
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Department of Cardiovascular Medicine, The Second Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Yan Fan
- Department of Cardiovascular Medicine, Gansu Provincial Hospital, Lanzhou, China
| | - Min Men
- Department of Endocrinology, Xi'an Central Hospital, Xi'an, China
| | - Guidong Shen
- Department of Cardiovascular Medicine, Ankang Central Hospital, AnKang, China
| | - Aiqun Ma
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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von Jeinsen B, Kraus D, Palapies L, Tzikas S, Zeller T, Schauer A, Drechsler C, Bickel C, Baldus S, Lackner KJ, Münzel T, Blankenberg S, Zeiher AM, Keller T. Urinary neutrophil gelatinase-associated lipocalin and cystatin C compared to the estimated glomerular filtration rate to predict risk in patients with suspected acute myocardial infarction. Int J Cardiol 2017; 245:6-12. [PMID: 28778467 DOI: 10.1016/j.ijcard.2017.07.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 06/02/2017] [Accepted: 07/21/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Impaired renal function, reflected by estimated glomerular filtration rate (eGFR) or cystatin C, is a strong risk predictor in the presence of acute myocardial infarction (AMI). Urinary neutrophil gelatinase-associated lipocalin (uNGAL) is an early marker of acute kidney injury. uNGAL might also be a good predictor of outcome in patients with cardiovascular disease. Aim of the present study was to evaluate the prognostic value of uNGAL compared to eGFR and cystatin C in patients with suspected AMI. METHODS 1818 patients were enrolled with suspected AMI. Follow-up information on the combined endpoint of death or non-fatal myocardial infarction was obtained 6months after enrolment and was available in 1804 patients. 63 events (3.5%) were registered. RESULTS While cystatin C and eGFR were strong risk predictors for the primary endpoint even adjusted for several variables, uNGAL was not independently associated with outcome: When applied continuously uNGAL was associated with outcome but did not remain a statistically significant predictor after several adjustments (i.e. eGFR). By adding cystatin C or uNGAL to GRACE risk score variables, only cystatin C could improve the predictive value while uNGAL showed no improvement. CONCLUSION We could show that cystatin C is an independent risk predictor in patients with suspected AMI and cystatin C can add improvement to the commonly used GRACE risk score. In contrast uNGAL is not independently associated with outcome and seems not to add further prognostic information to GRACE risk score.
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Affiliation(s)
- Beatrice von Jeinsen
- Division of Cardiology, Department of Internal Medicine III, Goethe University Frankfurt, Germany; German Centre for Cardiovascular Research (DZHK), partner site RheinMain, Frankfurt, Germany
| | - Daniel Kraus
- Division of Nephrology, Department of Medicine, University of Würzburg, Germany
| | - Lars Palapies
- Division of Cardiology, Department of Internal Medicine III, Goethe University Frankfurt, Germany
| | - Stergios Tzikas
- 3rd Department of Cardiology, Aristotle University of Thessaloniki, Ιppokrateio Hospital, Thessaloniki, Greece; Department of Internal Medicine II, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Tanja Zeller
- Clinic for General and Interventional Cardiology, University Heart Center Hamburg, Germany; German Centre for Cardiovascular Research (DZHK), partner site Hamburg/Lübeck/Kiel, Hamburg, Germany
| | - Anne Schauer
- Department of Internal Medicine II, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | | | - Christoph Bickel
- Department of Internal Medicine, Federal Armed Forces Hospital, Koblenz, Germany
| | - Stephan Baldus
- Department of Internal Medicine III, University of Cologne, Germany
| | - Karl J Lackner
- Department of Laboratory Medicine, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Thomas Münzel
- Department of Internal Medicine II, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Stefan Blankenberg
- Clinic for General and Interventional Cardiology, University Heart Center Hamburg, Germany; German Centre for Cardiovascular Research (DZHK), partner site Hamburg/Lübeck/Kiel, Hamburg, Germany
| | - Andreas M Zeiher
- Division of Cardiology, Department of Internal Medicine III, Goethe University Frankfurt, Germany; German Centre for Cardiovascular Research (DZHK), partner site RheinMain, Frankfurt, Germany
| | - Till Keller
- Division of Cardiology, Department of Internal Medicine III, Goethe University Frankfurt, Germany; German Centre for Cardiovascular Research (DZHK), partner site RheinMain, Frankfurt, Germany; Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany.
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Nakachi T, Kosuge M, Iinuma N, Kirigaya H, Kato S, Fukui K, Kimura K. ST-segment category at acute presentation is associated with the time course of coronary artery disease progression in patients with acute coronary syndromes. Heart Vessels 2016; 32:644-652. [PMID: 27826657 DOI: 10.1007/s00380-016-0917-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 11/04/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Several studies have shown higher early mortality for ST-segment elevation acute coronary syndrome (STEACS), but late mortality remains consistently higher for non-ST-segment elevation acute coronary syndrome (NSTEACS). We hypothesized that ST-segment category at acute presentation is associated with the time course of coronary artery disease progression (CP) of nonculprit lesions in patients with acute coronary syndrome (ACS). METHODS A total of 226 patients (182 men, age 65 ± 10 years) with STEACS (n = 95) or NSTEACS (n = 131) who underwent percutaneous coronary intervention (PCI) during initial hospitalization were studied. All patients underwent serial coronary angiograms (CAGs) performed immediately before PCI and at 7 ± 3 months and 60 ± 10 months after presentation. CP was defined as an increase in stenosis severity >15% of a nonculprit lesion between 2 serial CAGs. RESULTS The rate of CP between the first and second CAGs did not differ by ST-segment category at acute presentation. Compared to STEACS, NSTEACS had a higher rate of CP between the second and final CAGs (27.4 vs. 42.7%, P = 0.018). Multivariate analysis showed that the independent predictors of CP between the second and final CAGs were NSTEACS (odds ratio 2.709, P = 0.003), estimated glomerular filtration rate <60 ml/min/1.73 m2 (odds ratio 2.447, P = 0.015), and diabetes mellitus (odds ratio 2.135, P = 0.021). CONCLUSIONS Irrespective of conventional risk factors and angiographic findings, ST-segment category at initial presentation is associated with the persistency of widespread coronary disease activity following presentation in ACS patients undergoing PCI. This may partly explain the time-dependent differences in outcomes of patients with STEACS and NSTEACS.
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Affiliation(s)
- Tatsuya Nakachi
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomioka-higashi, Kanazawa-ku, Yokohama, Kanagawa, 236-8651, Japan.
| | - Masami Kosuge
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Naoki Iinuma
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomioka-higashi, Kanazawa-ku, Yokohama, Kanagawa, 236-8651, Japan
| | - Hidekuni Kirigaya
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomioka-higashi, Kanazawa-ku, Yokohama, Kanagawa, 236-8651, Japan
| | - Shingo Kato
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomioka-higashi, Kanazawa-ku, Yokohama, Kanagawa, 236-8651, Japan
| | - Kazuki Fukui
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomioka-higashi, Kanazawa-ku, Yokohama, Kanagawa, 236-8651, Japan
| | - Kazuo Kimura
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
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