Outcome and causes of renal deterioration evaluated by serial cystatin C measurements in acute coronary syndrome patients

• Verfasst von: Åkerblom, Axel [VerfasserIn]
• Verfasst von: Katus, Hugo [VerfasserIn]
• Titel: Outcome and causes of renal deterioration evaluated by serial cystatin C measurements in acute coronary syndrome patients
• Titelzusatz: results from the PLATelet inhibition and patient Outcomes (PLATO) study
• Verf.angabe: Axel Akerblom, Lars Wallentin, Agneta Siegbahn, Richard C. Becker, Andrzej Budaj, Jay Horrow, Steen Husted, Hugo Katus, Marc J. Claeys, Robert F. Storey, Nils Asenblad, and Stefan K. James
• Umfang: 7 S.
• Fussnoten: Gesehen am 09.04.2018
• Titel Quelle: Enthalten in: American heart journal
• Jahr Quelle: 2012
• Band/Heft Quelle: 164(2012), 5, S. 728-734
• ISSN Quelle: 1097-6744
• DOI: doi:10.1016/j.ahj.2012.08.017
• Datenträger: Online-Ressource
• Sprache: eng
• K10plus-PPN: 1571809171

Abstract

BACKGROUND: To investigate if ticagrelor treatment and other clinical characteristics were associated with increased cystatin C concentrations and if a deterioration in estimated renal function was associated with worse outcome in patients with acute coronary syndromes (ACS). METHODS: Plasma cystatin C concentrations were determined within 24 hours of admission (baseline), at discharge, 1 month, and 6 months in the PLATO trial. The changes over time in relation to randomized treatment were analyzed by analysis of covariance. C-statistics and the relative Integrated Discrimination Improvement of the cystatin C concentrations regarding the primary outcome (cardiovascular death or myocardial infarction) was evaluated by multivariable analysis including background characteristics and biomarkers: N-terminal-pro-B-type natriuretic peptide and Troponin I. RESULTS: Mean cystatin C concentrations in 2133 ticagrelor- and 2162 clopidogrel-treated patients were at baseline (0.86 mg/L and0.86 mg/L), discharge (1.01 mg/L and 0.98 mg/L) (P < .0005), 1 month (1.00 mg/L and 0.98 mg/L) (P = .12), and 6 months (1.00 mg/L and 0.99 mg/L) (P = .17), respectively. Age, heart failure, and type of ACS were major determinants of the cystatin C concentration. c Statistics and the relative Integrated Discrimination Improvement of the primary outcome for the baseline cystatin C concentration were 0.687 and 5.2%, compared to 0.684 and 4.5% at discharge (n = 4034) and 0.693 and 5.1% at one month (n = 3096), respectively. CONCLUSIONS: Mean cystatin C concentrations increased in ACS patients, most importantly determined by age. The initial greater increase in ticagrelor-treated patients was not sustained over time. Risk prediction did not improve with serial measurements of renal markers.