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Association between Cystatin C and Cardiac Function in Acute Myocardial Infarction Patients: A Real-World Analysis
Bowen Lou1,2, Yongbai Luo1,2, Haoxuan Zhang3,4
1Cardiovascular Department, First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an 710061, China.
Insights
Elevated Cystatin C (CysC) levels after acute myocardial infarction (AMI) correlate with poorer cardiac function and predict increased major adverse cardiovascular events (MACE) and mortality. This finding highlights CysC as a potential prognostic marker in AMI patients.
Area of Science:
- Cardiology
- Biomarkers
- Clinical Research
Background:
- Acute myocardial infarction (AMI) leads to significant morbidity and mortality, with cardiac dysfunction and remodeling predicting poor outcomes.
- Current understanding of post-AMI cardiac deterioration mechanisms is incomplete, and effective serum prediction markers are lacking.
- This study explores the association between in-hospital Cystatin C (CysC) levels and cardiac function/prognosis in AMI patients.
Purpose of the Study:
- To investigate the relationship between admission Cystatin C (CysC) levels and cardiac function parameters (ejection fraction, pro-BNP) in patients with acute myocardial infarction (AMI).
- To evaluate CysC as a predictor of major adverse cardiovascular events (MACE), cardiovascular mortality, and all-cause mortality in AMI patients.
Main Methods:
- Prospective observational study involving 5956 patients diagnosed with AMI.
- Measurement of admission CysC, ejection fraction (EF), and pro-BNP levels.
- Correlation analysis (simple and multiregression) and survival analysis (Kaplan-Meier) over a 48-month follow-up period in subgroups based on CysC levels (high vs. low).
Main Results:
- Admission CysC levels showed a significant positive correlation with pro-BNP and a negative correlation with ejection fraction (EF) in AMI patients.
- Patients with high admission CysC (≥1.09 mg/L) exhibited significantly increased incidence of MACE, cardiovascular mortality, and all-cause mortality compared to those with low CysC (<1.09 mg/L).
- Hazard ratios indicated a substantially higher risk for MACE, cardiovascular death, and all-cause mortality in the high CysC group.
Conclusions:
- Admission Cystatin C is negatively correlated with cardiac function (EF, pro-BNP) in acute myocardial infarction (AMI) patients.
- Cystatin C serves as a novel predictor for major adverse cardiovascular events (MACE) and mortality in the overall AMI population.
- Further research is warranted to elucidate the specific mechanisms underlying CysC's role in cardiac function deterioration post-AMI.
Background:
Acute myocardial infarction (AMI), as well as its long-term and short-term complications, is known to present with high morbidity and mortality. Cardiac function deterioration and ventricular remodelling after AMI are known to be correlated to worse long-term outcomes. However, the underlying mechanism remains elusive and there is a shortage of serum prediction markers. This study investigates the relationship between in-hospital Cystatin C (CysC) and cardiac function and subsequent prognosis among AMI patients. Research Design and Methods. We measured admission CysC and cardiac function parameters, including ejection fraction (EF) and pro-BNP value in 5956 patients diagnosed with AMI. Simple and multiregression analyses were performed to investigate the correlation between CysC and cardiac function in AMI patients. Major adverse cardiovascular events (MACE), cardiovascular, and all-cause mortality were documented, and 351 participants with high cystatin (≥1.09 mg/L) and 714 low cystatin (<1.09 mg/L) were investigated for survival analysis during a 48-month follow-up.
Results:
5956 patients with AMI were enrolled in the initial observational analysis, and 1065 patients of the whole cohort were included in the follow-up survival analysis. The admission CysC level was found to be significantly positively correlated to the pro-BNP level (R square = 0.2142, 95% CI 4758 to 5265, p < 0.0001) and negatively correlated to the EF value (R square = 0.0095, 95% CI -3.503 to -1.605, p < 0.0001). Kaplan-Meier survival analysis revealed significantly increased MACE incidence (HR = 2.293, 95% CI 1.400 to 3.755, p < 0.0001), cardiovascular mortality (HR = 3.016, 95% CI 1.694 to 5.371, p = 0.0002), and all-cause mortality (HR = 3.424, 95% CI 2.010 to 5.835, p < 0.0001) in high-admission CysC cohort with AMI at the end of 4-year follow-up.
Conclusions:
Admission CysC is negatively correlated with cardiac function in AMI patients and acts as a novel predictor for MACE incidence in the whole population. Further studies are needed to investigate the specific mechanism of CysC in the cardiac function deterioration among AMI patients.
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