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Published on: January 28, 2020
Different eGFR markers and prediction of cardiovascular risk
Maria Tydén1, Gorav Batra2,3, Bengt Fellström1
1Department of Medical Sciences, Renal Medicine, Uppsala University, Uppsala, Sweden.
Insights
In chronic coronary syndrome patients, lower estimated glomerular filtration rate (eGFR) values, whether cystatin C-based (eGFRcys) or creatinine-based (eGFRcr), indicate higher cardiovascular risk. Cystatin C-based eGFR showed the strongest association with major adverse cardiovascular events.
Area of Science:
- Nephrology
- Cardiology
- Biomarkers
Background:
- Renal dysfunction is a significant contributor to increased cardiovascular (CV) risk.
- Accurate assessment of kidney function is crucial for risk stratification in patients with chronic conditions.
- Comparing different markers of kidney function, such as cystatin C-based (eGFRcys) and creatinine-based (eGFRcr) estimated glomerular filtration rates, is essential for understanding their prognostic implications.
Purpose of the Study:
- To compare the prognostic value of eGFRcys, eGFRcr, and their ratio (eGFRcys/eGFRcr) in predicting major adverse cardiovascular events (MACE) and all-cause mortality.
- To assess the added prognostic value of the eGFR ratio beyond individual eGFR measures in patients with chronic coronary syndrome.
- To evaluate the association between renal dysfunction markers and cardiovascular outcomes in a large cohort.
Main Methods:
- Post hoc analysis of 14,513 patients from the Stabilization of Atherosclerotic Plaque by Initiation of Darapladib Therapy trial.
- Investigated associations between baseline eGFRcys, eGFRcr, and their ratio with MACE and all-cause death using Cox regression models.
- Assessed model discrimination using Harrell's C-index and added prognostic value using the fraction of new information (FNI).
Main Results:
- Lower eGFRcys, eGFRcr, and eGFR ratio were associated with increased MACE risk, primarily driven by cardiovascular death.
- eGFRcys demonstrated a stronger association with MACE (HR 1.77 when adjusted for eGFRcr) compared to eGFRcr (HR 0.82 when adjusted for eGFRcys).
- The eGFR ratio was linked to higher MACE risk (HR 1.99), with significant added value (FNI 54%) when adjusted for eGFRcr, but limited added value when adjusted for eGFRcys.
Conclusions:
- In patients with chronic coronary syndrome, reduced eGFRcys, eGFRcr, and eGFR ratio are associated with elevated MACE and mortality risk.
- eGFRcys exhibited the strongest prognostic association with cardiovascular events in this cohort.
- eGFRcr and the eGFR ratio provided limited incremental prognostic value beyond eGFRcys.
Background:
Renal dysfunction increases cardiovascular (CV) risk. We compared cystatin C-based estimated glomerular filtration rate (eGFRcys), creatinine-based eGFR (eGFRcr), and their ratio (eGFRcys/eGFRcr) in relation to major adverse cardiovascular events (MACE) and all-cause mortality in chronic coronary syndrome, assessing the added prognostic value of the eGFRratio.
Methods:
In this post hoc analysis of 14,513 Stabilization of Atherosclerotic Plaque by Initiation of Darapladib Therapy trial patients, we investigated associations between baseline eGFRcys, eGFRcr, their ratio, and MACE and all-cause death using Cox regression models, unadjusted and adjusted for eGFRcys, eGFRcr, and their combination. Discrimination was assessed using Harrell's C-index; added value by the fraction of new information (FNI).
Results:
Median age was 65 years; 82% were male. Median eGFRcys was 77 (interquartile range [IQR]: 61-94) and eGFRcr 79 (IQR: 65-91) mL/min/1.73 m2. Over 3.7 years, 1449 MACE and 1063 deaths occurred. Lower eGFR values and eGFRratio were associated with increased MACE risk, primarily driven by CV death. For eGFRcys 60 versus 90, the hazard ratio (HR) for MACE adjusted for eGFRcr was 1.77 (95% CI: 1.49-2.09, FNI 54%). In contrast, eGFRcr adjusted for eGFRcys showed no positive association (HR 0.82, 95% CI: 0.68-0.97, FNI 3%). A lower eGFRratio was linked to higher MACE risk (HR 1.99, 95% CI: 1.80-2.21), which remained after eGFRcr adjustment (HR 1.89, 95% CI: 1.70-2.10, FNI 54%) but was attenuated after eGFRcys adjustment (HR 1.29, 95% CI: 1.13-1.46, FNI 5%).
Conclusion:
In chronic coronary syndrome, lower eGFRcys, eGFRcr, and eGFRratio were associated with higher MACE and mortality risk. eGFRcys had the strongest association; eGFRcr and eGFRratio added limited incremental value.
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