umu.sePublications
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Prognostic impact of admisson level and dynamic change of cystatin C during an acute myocardial infarction
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
(English)Manuscript (preprint) (Other academic)
Abstract [en]

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.

Keyword [en]
myocardial infarction, cystatin C, acute kidney injury, chronic kidney disease
National Category
Cardiac and Cardiovascular Systems
Research subject
Cardiology
Identifiers
URN: urn:nbn:se:umu:diva-51094OAI: oai:DiVA.org:umu-51094DiVA: diva2:475113
Available from: 2012-01-10 Created: 2012-01-10 Last updated: 2016-05-23Bibliographically approved
In thesis
1. Platelet reactivity and comorbidities in acute coronary syndrome
Open this publication in new window or tab >>Platelet reactivity and comorbidities in acute coronary syndrome
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Trombocytreaktivitet och komorbiditet vid akut koronart syndrom
Abstract [en]

Background In the event of an acute coronary syndrome (ACS), the risk of death and complications such as stroke and re-infarction is high during the first month. Diabetes, impaired kidney function, elevated markers of systemic inflammation and high level of platelet reactivity have all been associated with worsened prognosis in ACS patients. Impaired kidney function is a condition with high cardiovascular morbidity and there is an established association between level of kidney function and outcome in the event of an ACS.

Aims We sought to investigate the level of platelet reactivity during the first days of an ACS and specifically the level of platelet reactivity in patients with different conditions associated with worsened prognosis in the event of an ACS. We also wanted to investigate the prognostic impact of baseline levels of cystatin C as well as the importance of decreasing kidney function during the first days of an ACS.

Methods We included 1028 unselected patients with ACS or suspected ACS during the years 2002 and 2003, of which 534 were diagnosed with an acute myocardial infarction (AMI). Blood samples for measuring platelet aggregation, cystatin C levels and other clinically important biomarkers were collected day 1, 2, 3 and 5 following admission.

Platelet reactivity was measured using 2 different methods. Platelet aggregation was measured using Pa-200, a particle count method, based on scattering of laser light. PFA 100 is a method of measuring primary hemostasis in whole blood.

Results

Platelet aggregation and comorbidities.

We found an increase in platelet aggregation when an ACS was complicated by an infection and there was an increased frequency of aspirin non-responsiveness in patients suffering from pneumonia during the first days of an ACS. Furthermore, we found an independent association between levels of C-reactive protein and platelet aggregation.

During the first 3 days following an acute myocardial infarction, platelet aggregation increased despite treatment with anti-platelet agents.

Platelet aggregation was found to be more pronounced in patients with diabetes.

Patients with impaired kidney function, showed increased platelet aggregation compared to patients with normal renal function, however, this difference was explained by older age, higher prevalence of DM and levels of inflammatory biomarkers. We found no independent association between chronic kidney disease (CKD) and levels of platelet aggregation.

Kidney function and outcome

Serum levels of cystatin C on admission had an independent association with outcome following an acute myocardial infarction. With a mean follow-up time of 2.9 years, the adjusted HR for death was 1.62 (95% CI 1.28-2.03; p<0.001) for each unit of increase in cystatin C on admission.

The level of dynamic changes in cystatin C during admission for an acute myocardial infarction was independently associated with prognosis in patients with normal or mild impairment of renal function. The adjusted HR for death was 10.1 (95% CI 3.4-29.9; p<0.001).

Conclusion In patients suffering from an AMI platelet aggregation increases during the first days, despite anti-platelet treatment. Diabetes, age and biomarkers of inflammation are independently associated with platelet aggregation.

Admission levels of cystatin C as well as changes in cystatin C levels during hospitalisation are independently associated with outcome.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2012. 53 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1477
Keyword
acute coronary syndrome, myocardial infarction, platelet reactivity, platelet aggregation, Inflammation, infection, diabetes mellitus, chronic kidney disease, acute kidney injury
National Category
Cardiac and Cardiovascular Systems
Research subject
Cardiology
Identifiers
urn:nbn:se:umu:diva-51096 (URN)978-91-7459-361-7 (ISBN)
Public defence
2012-02-17, Hörsalen, Östersunds Sjukhus, Östersund, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2012-01-27 Created: 2012-01-10 Last updated: 2012-01-27Bibliographically approved

Open Access in DiVA

No full text

Search in DiVA

By author/editor
Björklund, FredrikModica, AngeloMooe, Thomas
By organisation
Medicine
Cardiac and Cardiovascular Systems

Search outside of DiVA

GoogleGoogle Scholar

urn-nbn

Altmetric score

urn-nbn
Total: 92 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf