Prognostic ability of cystatin C and homocysteine plasma levels for long-term outcomes in very old acute myocardial infarction patients

Abstract

Background and aimsThis study sought to evaluate the prognostic powers of combined use of cystatin C (Cys C) and homocysteine (Hcy) at predicting adverse events of patients >80 years old with acute myocardial infarction (AMI).Patients and methodsThe analysis involved 753 patients >80 years old undergoing coronary angiography for chest pain in China from January 2006 to December 2012. Kaplan–Meier method was used for survival and major adverse cardiac events (MACE) rates. Multivariate Cox regression was performed to identify mortality predictors. Receiver operating characteristic curve analysis was performed to predict the cutoff values of Cys C and Hcy for all-cause mortality.ResultsThe duration of follow-up was 40–116 months (median, 63 months; interquartile range, 51–74 months). The long-term survival and event-free survival rates of AMI patients were significantly lower than those of unstable angina pectoris patients (P<0.05), and were significantly different according to the tertile concentration of Cys C of AMI patients (P<0.01). Cys C and Hcy were independent risk factors for long-term all-cause mortality (odds ratio [OR] =3.72 [2.27–6.09]; OR =1.59 [1.04–2.61]) and MACE (OR =2.83 [1.82–4.40]; OR =1.09 [1.04–1.21]) of AMI patients. The predictive cutoff value of Cys C was 1.815 mg/L (82.8%, 86.4%) and that of Hcy was 15.06 μmol/L (84.4%, 83.1%) in AMI patients. Combined use of both biomarker’s cutoff values further increased the sensitivity and specificity of all-cause mortality.ConclusionCys C is a strong independent predictor of long-term all-cause death and MACE in very old AMI patients. The combined use of Cys C and Hcy further improves the predictive accuracy.

Whole genome sequencing in the Middle Eastern Qatari population identifies genetic associations with 45 clinically relevant traits

“…CSTB is a member of the cystatin superfamily that encodes the Cystatin B protein that functions as protease inhibitor. It has been shown that Cystatin C, another member of cystatin superfamily, is a determinant of serum levels of Hcyst 14 , 15 . We also identified a novel locus associated with two related coagulation traits (PT and INR) on chromosome 13 situated near LINC01070 , a gene that encodes a long noncoding RNA.…”

The UA Doppler Index, Plasma HCY, and Cys C in Pregnancies Complicated by Congenital Heart Disease of the Fetus

“…Cys C is a strong independent predictor of long-term all-cause death and major adverse cardiac events in elderly patients with acute myocardial infarction. The combined detection of Cys C and HCY further improves the predictive value [ 25 ]. Cys C can inhibit HCY decomposition, increase its concentration in blood, and interact with factors including plasma HCY and histones, thereby increasing the risk of hypertension and gestational diabetes in pregnant women and further increasing the risk of premature birth, miscarriage, and fetal intrauterine growth restriction [ 26 ].…”

Effects of insulin combined with metformin on serum cystatin C, homocysteine and maternal and neonatal outcomes in pregnant women with gestational diabetes mellitus

“…The above results suggest that insulin combined with metformin can effectively reduce the serum Cys C and Hcy levels of patients, thus improving the patient's condition. Previous findings have indicated that the therapeutic effect and complications of patients with GDM could be predicted by monitoring factors in serum of patients with GDM (24).…”