Diagnostic and prognostic value of cystatin C in acute coronary syndrome: An up-to-date meta-analysis

Abstract

Background: The role of Cystatin C (CysC) in the diagnosis and prognosis of cardiovascular disease, particularly acute coronary syndrome (ACS), is increasingly significant. The goal of this meta-analysis was to assess the diagnostic and prognostic value of CysC in patients with ACS, as well as its association with major adverse cardiovascular events (MACE), defined as mortality, myocardial infarction, heart failure, and stroke.

Methods: The present study is a systematic review and meta-analysis. Using PubMed, Web of Science, Cochrane Library, and Embase, a literature review of cohort and case control studies reporting MACE and using the terms ACS and Cystatin C was conducted, excluding studies published after August 1, 2024. the meta-analysis using a random effects model.

Results: CysC concentrations were significantly higher in patients with ACS compared to controls [mean difference (MD) = 0.36, p < 0.001], and in acute myocardial infarction (AMI) vs. unstable angina (MD = 0.18, p < 0.001). No significant differences were observed between ST elevation myocardial infarction (STEMI) and Non-ST elevation myocardial infarction (NSTEMI). Patients with MACE had higher CysC levels than those without (MD = 0.25, p < 0.001). Hospital survivors had lower CysC levels compared to those who died (MD = -0.25, p < 0.001). Higher CysC concentrations were associated with increased risks of MACE, cardiac death, overall mortality, myocardial reinfarction, and stroke, both during hospitalization and beyond.

Conclusions: CysC is a promising biomarker for both diagnosis and prognosis in patients with ACS, especially in the context of predicting MACE, mortality and heart failure risk. The use of CysC may improve risk stratification and support therapeutic decision-making in clinical practice.

Keywords: ACS; acute coronary syndrome; biomarker; cystatin C; diagnosis; meta-analysis; prognosis.

Figure 1

PRISMA flow chart of the included studies

Figure 2

A graphical representation of the origin of the studies included in the meta-analysis

Figure 3

Forest pot demonstrating cystatin C concentrations among ACS and Control groups; ACS — acute coronary syndrome; CI — confidence interval; SD — standard deviation

Figure 4

Forest pot demonstrating cystatin C concentrations among AMI and UAP groups; AMI — acute myocardial infarction; CI — confidence interval; SD — standard deviation; UAP — unstable angina

Figure 5

Forest pot demonstrating cystatin C concentrations among patients with and without MACE; CI — confidence interval; MACE — major advance cardiovascular event occurrence; SD — standard deviation

Figure 6

Forest pot demonstrating cystatin C concentrations among survived vs. decreased patients; CI — confidence interval; SD — standard deviation