Abstract 2659: Increased Cystatin C Serum Levels Improve Risk Stratification in Patients with Acute Coronary Syndrome and Normal Glomerular Filtration Rate

Abstract

Use of Cystatin C serum levels (CC) is a more sensible marker of renal function than serum Creatinine levels (Cr) and Glomerular Filtration Rate (GFR). Previous studies have shown that increased serum CC levels with normal GFR in a population with cardiovascular risks factors but without any cardiovascular disease is associated with increased cardiovascular events but this was not analyzed in ischemic heart disease patients. We prospectively studied 203 patients hospitalized with Acute Coronary Syndrome (ACS). Serum CC levels were determined in the first 24 hours of hospitalization in all cases and two groups were identified (>and< 0.95 mg/L). GFR was calculated by MDRD formulation using the first serum Cr determination in all patients and were established two groups (> and < 60 ml/min/1.73m2). Coronariography was performed in all patients. During 13 months follow-up period we analyzed Mayor Adverse Coronary Events (MACE) and Mortality. Patients with serum CC levels >0.95 were older, with higher hypertension prevalence, prior stroke, high frequency of renal disease and greater severity of coronary artery disease (42% patients with three-vessel coronary artery disease, p=0.05). During the follow-up these patients showed a significantly higher risk of heart failure new-onset (62% p=0.001) and mortality (14 %, p=0.001). Patients with GFR >60 and serum CC levels <0.95 presented significantly higher values of MACE (61%; p=0.001) and mortality (8%; p=0.001) in opposition to 18% and 3% respectively in the group of patients with GFR 3 60 and serum CC levels 30.95. Nevertheless significant prognostic differences between GFR >60 and serum CC levels <0.95 group and GFR >60 and serum CC levels >0.95 group were observed. In the multivariate analysis was observed than serum CC levels was an independent predictor to develop of new-onset heart failure (RR: 3.9 CI 95% 1.5–9.9; p=0.002), and mortality (RR: 2. CI 95% 1.2–3.6, p=0.001) during the follow-up. Serum CC levels are a powerful both mortality and heart failure predictor in patients with high risk ACS. High serum CC levels in patients with ACS and normal renal function identify a higher risk group. Serum CC determination may be include in the risk evaluation of patients with ACS.