Long-term prognostic impact of cystatin c on acute coronary syndrome octogenarians with diabetes mellitus

Zhenhong Fu,Wei Dong,Hao Xue,Zhijun Sun,Yundai Chen,Hongbin Liu,Luyue Gai,Lian Chen,Jun Guo

doi:10.1186/1475-2840-12-157

Abstract

ObjectiveCystatin C (Cys C) is a marker of renal dysfunction. Prior studies have shown that blood Cys C is related to the prognosis of coronary heart disease. The aim of the present study was to evaluate the long-term prognostic impact of Cys C on acute coronary syndrome (ACS) octogenarians with diabetes mellitus (DM).MethodsWe enrolled 660 consecutive ACS octogenarians who underwent coronary angiography and were classified into two groups based on diabetes. The baseline characters and Cys C level were measured on admission. Survival curve was calculated using the Kaplan-Meier method. Multivariate Cox regression was used to identify predictors of mortality and of major adverse cardiac events (MACE) rate.ResultsThere were 223 and 398 patients in groups DM and non-DM who fulfilled the follow-up. The average follow-up period was 28 (IQR 16–38) months. Diastolic blood pressure (DBP) was lower, ratios of hypertension and chronic renal failure (CRF), fasting blood glucose, HbA1c and Cys C levels were higher in DM group than those in non-DM group (P<0.01). The cumulative survival of DM group was significantly lower than that of non-DM group in the long term (P = 0.018). All cause mortality and MACE of DM group were higher than those of non-DM group (P<0.05). The plasma Cys C concentration (OR = 3.32, 95% CI = 1.18-10.92, P = 0.023) was the uniqueness independent predictor for long-term all cause mortality. The plasma Cys C concentration (OR = 2.47, 95% CI = 1.07-7.86, P = 0.029) and Genesis score (OR = 1.01, 95% CI = 1.00-1.03, P = 0.043) were independent predictors for MACE in DM group. ROC curve analysis showed that the predictive cut-off value of Cys C for mortality of DM group was 1.605 (0.718, 0.704).ConclusionsCys C is an independent predictor for long-term mortality and MACE of ACS octogenarians with DM.

Highlights

The older population represents a growing proportion of the general population
After being adjusted for age, gender, heart rate, body mass index (BMI), TG, total cholesterol (TC), low density lipoprotein-C (LDL-C), fasting blood glucose (FBG), HBA1c, Systolic blood pressure (SBP), Diastolic blood pressure (DBP) and eject fraction (EF), the plasma Cystatin C (Cys C) concentration (OR = 3.32, 95% Confidence interval (CI) = 1.18-10.92, P = 0.023) was the unique independent predictor for longterm mortality, and the plasma Cys C concentration (OR = 2.47, 95% CI = 1.07-7.86, P = 0.029) and Genesis score (OR = 1.01, 95% CI = 1.00-1.03, P = 0.043) were independent predictors for major adverse cardiac events (MACE) in Diabetes mellitus (DM) group
In the present study, we have found that plasma Cys C concentration was an independent predictor for longterm mortality and MACE in acute coronary syndrome (ACS) octogenarians with DM after controlling for conventional cardiovascular risk factors, but not for those without DM

Summary

Introduction

The older population represents a growing proportion of the general population. Octogenarian (age >80 years old) will increase from the current ratio of 1 in 35 to more than 1 in 12 by the year 2050 [1]. The increasing prevalence of coronary artery disease (CAD) is associated with aging. Cystatin C (Cys C) is a cysteine protease inhibitor with a low-molecular weight (13 kD) that is produced by all nucleated cells at a constant rate. It is freely filtered across the glomerular membrane and is not influenced by age, sex, muscle mass, exercise or diet [4]. Cys C level is associated with the prognosis of CAD in the general population [7,8,9,10,11]. The findings strongly suggest Cys C is associated with the development of cardiovascular disease (CVD) and the incidence of type 2 DM.

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