Abstract
ObjectiveWe investigated whether and to what extent cystatin C was associated with angiographic coronary collateralization in patients with stable coronary artery disease and chronic total occlusion.MethodsSerum levels of cystatin C and high-sensitive C-reactive protein (hsCRP) and glomerular filtration rate (GFR) were determined in 866 patients with stable angina and angiographic total occlusion of at least one major coronary artery. The degree of collaterals supplying the distal aspect of a total occlusion from the contra-lateral vessel was graded as poor (Rentrop score of 0 or 1) or good coronary collateralization (Rentrop score of 2 or 3).ResultsIn total, serum cystatin C was higher in patients with poor collateralization than in those with good collateralization (1.08 ± 0.32 mg/L vs. 0.90 ± 0.34 mg/L, P < 0.001), and correlated inversely with Rentrop score (adjusted Spearmen’s r = -0.145, P < 0.001). The prevalence of poor coronary collateralization increased stepwise with increasing cystatin C quartiles (P for trend < 0.001). After adjusting for age, gender, risk factors for coronary artery disease, GFR and hsCRP, serum cystatin C ≥ 0.97 mg/L remained independently associated with poor collateralization (OR 2.374, 95% CI 1.660 ~ 3.396, P < 0.001). The diagnostic value of cystatin C levels for detecting poor coronary collateralization persisted regardless of age, gender, presence or absence of diabetes, hypertension or renal dysfunction.ConclusionsSerum cystatin C reflects angiographic coronary collateralization in patients with stable coronary artery disease, and cystatin C ≥ 0.97 mg/L indicates a great risk of poor coronary collaterals.
Highlights
Coronary collateral vessels are interarterial connections that potentially offer an alternative source of blood supply to a vascular territory subtended by occluded coronary arteries [1, 2]
After adjusting for age, gender, risk factors for coronary artery disease, glomerular filtration rate (GFR) and high-sensitivity C-reactive protein (hsCRP), serum cystatin C 0.97 mg/L remained independently associated with poor collateralization
Serum cystatin C reflects angiographic coronary collateralization in patients with stable coronary artery disease, and cystatin C 0.97 mg/L indicates a great risk of poor coronary collaterals
Summary
Coronary collateral vessels are interarterial connections that potentially offer an alternative source of blood supply to a vascular territory subtended by occluded coronary arteries [1, 2]. Cystatin C, an endogenous anti-angiogenic factor, was considered as an emerging biomarker in cardiovascular disease and proved to be an important predictor for adverse outcomes among patients with coronary artery disease [13,14,15]. Since early detection of poor coronary collateralization may have clinical relevance as cardiovascular mortality associated with coronary artery disease with or without diabetes or chronic kidney disease is significantly higher partly due to impaired coronary collateralization [1,2,3], it is pertinent to examine the relationship between serum cystatin C and coronary collateralization in patients with stable coronary artery disease. We hypothesized that elevated cystatin C level is an indicator of poor coronary collateralization in patients with stable coronary artery disease. Serum levels of high-sensitivity C-reactive protein (hsCRP) were determined to compare inflammatory condition in these patients
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