Prognostic impact of admisson level and dynamic change of cystatin C during an acute myocardial infarction
(English)Manuscript (preprint) (Other academic)
Introduction: Impaired kidney function has emerged as an important risk factor for developing cardiovascular disease. The level of kidney function is also associated with outcome following an acute coronary syndrome. Acute kidney injury during hospitalisation for an acute coronary syndrome has been associated with worsened prognosis. The aim of this study was to investigate the prognostic impact of kidney function on admission and sign of worsening kidney function during hospitalisation as measured by levels of cystatin C.
Materials and methods: Five hundred and thirty-four patients admitted for an acute myocardial infarction were included. Cystatin C and other biochemical markers were obtained on day 1, 2, 3 and 5 depending on length of hospital stay.
Results: At a median follow-up of 2.9 years, the endpoint (death) had occurred in 176 (33%) patients. High admission level of cystatin C was independently associated with increased risk of death, at a hazard ratio of 1.62 (95% CI 1.28-2.03). The maximum recorded difference between levels of cystatin C in-hospital, were independently associated with outcome in patients with estimated glomerular filtration rate on admission>60 ml/(min*1.73m²). Hazard ratio for death at follow-up were 10.14 (95% CI 3.44-29.92) in this patient group.
Conclusion: Level of kidney function on admission, as estimated by serum level of cystatin C, is independently associated with death at long-term follow up. In patients without chronic kidney disease, changing levels of cystatin C during admission for an AMI, have a strong impact on long-term prognosis. We found no additional information provided by dynamic changes in cystatin C, besides established predictors, in patients with chronic kidney disease.
myocardial infarction, cystatin C, acute kidney injury, chronic kidney disease
Cardiac and Cardiovascular Systems
Research subject Cardiology
IdentifiersURN: urn:nbn:se:umu:diva-51094OAI: oai:DiVA.org:umu-51094DiVA: diva2:475113