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

Area of Science:

• Cardiology
• Nephrology
• Biomarkers

Background:

• Assessing renal function is crucial for predicting cardiovascular events in patients with chronic total occlusion (CTO) undergoing percutaneous coronary intervention (PCI).
• Existing creatinine-based estimates of kidney function may not fully capture renal status in this population.
• The predictive value of cystatin C-based estimated glomerular filtration rate (eGFR) for adverse outcomes in CTO PCI patients requires further investigation.

Purpose of the Study:

• To compare the predictive performance of serum cystatin C-based eGFR against multiple creatinine-based eGFR equations for adverse cardiovascular events in patients with CTO undergoing PCI.
• To determine if cystatin C-based eGFR offers improved prognostic value for all-cause mortality and cardiac death.

Main Methods:

• Retrospective study including 671 patients who underwent CTO PCI.
• Calculated eGFR using modification of diet in renal disease (cMDRD) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations.
• Categorized patients into KDIGO kidney stages based on eGFR and analyzed primary (all-cause mortality) and secondary (cardiac death) endpoints.

Main Results:

• Serum cystatin C-based eGFR demonstrated superior predictive performance, indicated by a larger area under the receiver operating characteristic (ROC) curve for both all-cause mortality (0.73) and cardiac death (0.73).
• Cystatin C-based eGFR showed the highest prognostic value for all-cause mortality (adjusted HR 3.6) and cardiac death (adjusted HR 2.9) compared to other formulas.
• Cystatin C-based eGFR significantly improved risk reclassification, evidenced by high net reclassification improvement and integrated discrimination improvement.

Conclusions:

• Serum cystatin C-based eGFR is a more effective predictor of all-cause mortality and cardiac death than traditional creatinine-based equations in patients with CTO undergoing PCI.
• This finding highlights the potential clinical utility of cystatin C-based eGFR for risk stratification in this high-risk cardiovascular patient group.