Time course changes of cystatin C and inflammatory and biochemical markers in non-ST-elevation acute coronary
Stefano De Servi1, Giuseppe Mariani, Luigi Piatti
1aCardiovascular Department, AO 'Ospedale Civile', Legnano bDivision of Cardiology, Manzoni Hospital, Lecco cDivision of Cardiology, Misericordia e Dolce Hospital, Prato dDivision of Cardiology, AO 'Villa Scassi', Genova eDivision of Cardiology, Ospedali Riuniti, Treviglio fCardiology Unit, Spedali Civili, Brescia gDivision of Cardiology, St Antonio Abate Hospital, Gallarate hDivision of Cardiology, Desio Hospital, Desio iDivision of Cardiology, Terni Hospital, Terni jLaboratory Unit, AO 'Ospedale Civile' di Legnano, Italy.
Insights
Serum cystatin C (Cys-C) reliably indicates renal function in non-ST-elevation acute coronary syndromes (NSTE-ACS). Unlike inflammatory markers, Cys-C levels remain stable post-discharge, unaffected by myocardial necrosis.
Area of Science:
- Cardiology
- Nephrology
- Clinical Chemistry
Background:
- Serum cystatin C (Cys-C) is a recognized marker for renal function and prognosis in non-ST-elevation acute coronary syndromes (NSTE-ACS).
- Limited data exist on the longitudinal changes of Cys-C levels after hospital discharge in NSTE-ACS patients.
- This study investigated the time course of Cys-C and its relationship with other biomarkers in a select NSTE-ACS cohort.
Purpose of the Study:
- To evaluate the changes in serum cystatin C (Cys-C) levels from admission to 6 weeks post-discharge in patients with non-ST-elevation acute coronary syndromes (NSTE-ACS).
- To compare the behavior of Cys-C with inflammatory markers (high-sensitivity C-reactive protein, interleukin-6) and cardiac stress markers (troponin, NT-proBNP) over time.
- To assess the correlation of Cys-C with estimated glomerular filtration rate (eGFR) in this patient population.
Main Methods:
- Prospective, multicentre study involving patients with a first NSTE-ACS, single-vessel disease, and successful percutaneous coronary interventions (PCIs).
- Serum samples were collected during admission (ACS sample) and at 6 weeks after discharge.
- Analysis included measurements of Cys-C, troponin (c-TNT), hsCRP, IL-6, and NT-proBNP, with correlation to eGFR.
Main Results:
- Serum Cys-C levels showed a slight but significant increase from the ACS sample to the 6-week sample.
- In contrast, hsCRP, NT-proBNP, and IL-6 levels significantly decreased over the same period.
- Elevated c-TNT levels were associated with higher inflammatory and stress markers, but Cys-C levels were similar regardless of c-TNT status. Cys-C strongly correlated with eGFR.
Conclusions:
- Serum cystatin C (Cys-C) serves as a stable and reliable marker of renal function in NSTE-ACS patients.
- Unlike inflammatory and biochemical stress markers, Cys-C is not significantly influenced by myocardial necrosis or acute left-ventricular impairment.
- The findings support the utility of Cys-C for assessing renal function throughout the NSTE-ACS continuum of care.
Background:
Serum cystatin C (Cys-C), a good marker of renal function, predicts prognosis in non-ST-elevation acute coronary syndromes (NSTE-ACS). However, no data are available on the time course of Cys-C values after discharge. In this study, Cys-C was measured during admission (ACS sample) and 6 weeks after discharge, and was correlated with troponin (c-TNT), high-sensitivity C-reactive protein (hsCRP), interleukin 6 (IL-6) and the N-terminal portion of the pro-brain natriuretic peptide (proBNP) peptide (NT-proBNP) in a highly selected homogeneous group of NSTE-ACS patients.
Methods:
In this prospective, multicentre study, patients with a first NSTE-ACS, single-vessel disease and successful percutaneous coronary interventions (PCIs) had their sera collected, aliquoted and stored at the enrolling site and then shipped for analysis to the clinical chemistry core laboratory.
Results:
Cys-C values slightly, but significantly, increased from the ACS samples to the 6-week samples. In contrast, hsCRP, NT-proBNP and IL-6 values significantly decreased from the ACS to the 6-week sample. Patients with elevated c-TNT levels had higher hsCRP, NT-proBNP and IL-6 values than patients with normal c-TNT levels in the ACS sample, whereas Cys-C levels were similar in patients with and without elevated c-TNT. Cys-C was highly correlated with estimated glomerular filtration rate in both the ACS and 6-week samples.
Conclusions:
In contrast to inflammatory and biochemical stress markers, Cys-C is not affected by the occurrence of myocardial necrosis or by acute left-ventricular impairment, being a reliable marker of renal function during NSTE-ACS.
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