Cystatin C-Based Renal Function in Predicting the Long-Term Outcomes of Chronic Total Occlusion After Percutaneous Coronary Intervention.

Bolin Li,Yue Wu,Hongbing Li,Youlong Pan,Hui Huang,Xiao-Zhen Zhuo,Xing Wen,Lele Cheng,Jie Rong,Bobo Wang,Ke Gao,Zhijie Jian,Shanshan Li,Yi-Ming Hua,Yujing Zhang

doi:10.3389/fcvm.2020.586181

Abstract

Renal function estimated by various biomarkers predicting for adverse cardiovascular events has not been well-identified in received percutaneous coronary intervention (PCI) for chronic total occlusion (CTO), the advanced stages of atherosclerosis. We aim to determine whether the serum cystatin C-based-estimated glomerular filtration rate (eGFR) can have an improved predictive value in patients with CTO lesions undergoing PCI as compared with multiple creatinine-based estimates of kidney function. Six hundred and seventy-one patients received CTO PCI were retrospectively included in the study. The eGFR was calculated by modification of diet in renal disease equation for Chinese (cMDRD) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations at baseline, respectively. Then, the cohort was categorized into three groups according to standard KDIGO kidney stages based on eGFR. The primary endpoint was all-cause mortality, and the secondary endpoint was cardiac death. Strikingly, cystatin C-based eGFR showed a better performance with the greater area being under the receiver operating characteristic (ROC) curve (0.73 for all-cause mortality and 0.73 for cardiac death, separately) and a better assessment for survival free from adverse event across renal levels among four eGFR equations. Compared with eGFR calculated by other formulas, serum cystatin C-based eGFR showed the highest prognostic value for both all-cause mortality (adjusted HR 3.6, 95% CI 1.6–8.1, P = 0.002) and cardiac death (adjusted HR 2.9, 95% CI 1.0–8.1, P = 0.028). Moreover, cystatin C-based eGFR significantly improved the risk reclassification of event with a high value of net reclassification improvement and integrated discrimination improvement. This study may prove that cystatin C-based eGFR is a better predictor of both all-cause mortality and cardiac death than other equations in populations with CTO undergoing PCI.

Highlights

Renal insufficiency has been found to increase the incidence of both cardiovascular diseases and adverse outcome [1]
Current recommendations and guidelines [2] have pointed out that the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) creatinine equation can be applied to estimate GFR with better accuracy than the modification of Diet in Renal Disease (MDRD) equation, as the actual GFR in patients with preserved renal function may be underestimated by using MDRD [3, 4]
This study showed an increase in all-cause mortality and cardiac death after chronic total occlusion (CTO) percutaneous coronary intervention (PCI) as baseline renal function declined

Summary

Introduction

Renal insufficiency has been found to increase the incidence of both cardiovascular diseases and adverse outcome [1]. Cystatin C is a 13-kDa protein and a member of the family of competitive lysosomal cysteine protease inhibitors. Several studies have shown a very close relationship between cystatin C and cardiovascular events, especially cardiac death and all-cause mortality [6], among different cohorts, such as patients with chronic kidney disease(CKD) [7] and the elderly people [8]. These studies have revealed that cystatin C-based eGFR can be an earlier and stronger predictor for predicting adverse cardiovascular outcomes as compared with creatinine-based eGFR

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Conclusion