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. 2024 Aug 31;14(4):621-629.
doi: 10.21037/cdt-23-482. Epub 2024 Aug 16.

Association of serum cystatin C level and major adverse cardiovascular events in patients with percutaneous coronary intervention

Zhibin Xiao #  1 , Aoge Riletu #  2 , Xiaoyu Yan  1 , Qi Meng  1 , Weiru Zhang  1 , Na Zhang  1 , Chi Ma  1 , Xin Guo  1 , Jiatong Han  1 , Huijuan Nie  3 , Hui Deng  4 , Jing Liu  5 , Jianping Chen  6 , Yu Dong  7   8 , Tianlong Liu  5   9
Affiliations

Association of serum cystatin C level and major adverse cardiovascular events in patients with percutaneous coronary intervention

Zhibin Xiao et al. Cardiovasc Diagn Ther. .

Abstract

Background: Recurrent acute myocardial infarction requiring unplanned percutaneous coronary intervention (PCI) is one of the major adverse cardiovascular events (MACEs) in patients with acute coronary syndrome (ACS) after PCI. There is a continuing controversy about the association between serum cystatin C, a biomarker for the evaluation of renal function, and the prognosis of ACS patients following PCI. The retrospective study evaluated the association between serum cystatin C level and MACE in ACS patients after PCI.

Methods: Data were retrieved for 330 patients with ACS for primary PCI in a single center. Serum cystatin C levels were measured before PCI. All patients underwent regular follow-ups after PCI, and the studied endpoint was MACE, defined as the need for a repeat revascularization in the heart. The predictive value of serum cystatin C for MACE was analyzed using univariate and multivariate analysis. Restricted cubic spline (RCS) analysis was applied to evaluate the dose-response relationship between serum cystatin C level and MACE in ACS patients following PCI.

Results: After a median follow-up of 63 months (range, 1-148 months), 121 of the 330 patients experienced MACE. Compared to patients who did not have MACE, patients who had MACE showed a significant decrease in serum cystatin C levels (0.99±0.32 vs. 1.15±0.78 mg/L, P=0.03). In multivariate regression analysis, serum cystatin C level was an independent risk factor for MACE. According to the serum cystatin C level, patients were divided into 4 categories, Cox regression analysis illustrated that the second quartile of serum cystatin C level indicated an increased risk of MACE in patients with PCI for primary ACS compared to the highest quartile [Q2: adjusted hazard ratio (HR) =2.109; 95% confidence interval (CI): 1.193-3.727; P=0.01]. RCS analysis showed a significant U-shaped dose-response relationship between cystatin C level and MACE in patients with PCI for ACS (P for non-linearity =0.004).

Conclusions: These results indicated an association between serum cystatin C level and post-PCI MACE in ACS patients.

Keywords: Cystatin C; U-shaped dose-response relationship; acute coronary syndrome (ACS); major adverse cardiovascular events (MACEs); percutaneous coronary intervention (PCI).

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://cdt.amegroups.com/article/view/10.21037/cdt-23-482/coif). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Study schematic diagram.
Figure 2
Figure 2
Kaplan-Meier event-free survival curve. Kaplan-Meier analysis of MACE based on quartiles of serum cystatin C level in ACS patients after PCI (log-rank, P=0.003). Quartiles of serum cystatin C: Q1 ≤0.84 mg/L; 0.84< Q2 ≤0.96 mg/L; 0.96< Q3 ≤1.12 mg/L; Q4 >1.12 mg/L. MACE: a major adverse cardiovascular event, is defined as the need for repeat revascularization in the heart. CI, confidence interval; ACS, acute coronary syndrome; PCI, percutaneous coronary intervention.
Figure 3
Figure 3
The nonlinear relationship between cystatin C level and MACE in ACS patients undergoing PCI. The shaded area represents the 95% CI. MACE: a major adverse cardiovascular event, is defined as the need for repeat revascularization in the heart. HR, hazard ratio; CI, confidence interval; ACS, acute coronary syndrome; PCI, percutaneous coronary intervention.
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