Cystatin C and risk of mortality among patients undergoing percutaneous coronary intervention

Fabio Angeli, Paolo Verdecchia, Stefano Savonitto, Gustavo Arraiz, Martina Zaninotto, Andrea Broccatelli, Chiara Cosma, Stefano De Servi, Federico Sabino, Carlo Briguori, Giuseppe Ambrosio, Claudio Cavallini

Research output: Contribution to journalArticle

Abstract

Aims: We tested the prognostic value of cystatin C in patients with documented coronary artery disease (CAD) who underwent percutaneous coronary artery intervention (PCI). We also tested the hypothesis that the incremental predictive value of cystatin C on all-cause mortality was superior to that of glomerular filtration rate (GFR) by the Modification of Diet in Renal Disease (MDRD) formula. Methods and results: Included in the study were 2,757 patients (mean age 63 years, 77% men). Blood samples for cystatin C levels were collected immediately before PCI. During a median follow-up of two years, 114 patients died. In multivariable Cox analyses, after adjustment for several confounders, GFR (p=0.004) and cystatin C concentration (p<0.0001) were independent predictors of all-cause death. Cystatin C predicted all-cause death (c-statistic: 0.794) better than GFR estimate based on creatinine (c-statistic: 0.776, p=0.008 for comparison), and significantly reclassified 15% of patients into categories that reflected their actual likelihood of death more accurately (p=0.005). Adding cystatin C and GFR in the same multivariable survival model, only cystatin C level was a significant predictor of death. Conclusions: This study presents for the first time the incremental predictive value of cystatin C over the creatinine-based MDRD formula on all-cause mortality for CAD patients undergoing PCI.

Original languageEnglish
Pages (from-to)757-764
Number of pages8
JournalEuroIntervention
Volume11
Issue number7
DOIs
Publication statusPublished - Nov 1 2015

Fingerprint

Cystatin C
Percutaneous Coronary Intervention
Mortality
Glomerular Filtration Rate
Diet Therapy
Coronary Vessels
Coronary Artery Disease
Cause of Death
Creatinine
Kidney
Survival

Keywords

  • Coronary artery disease
  • Cystatin C
  • Estimated glomerular filtration rate
  • Percutaneous transluminal coronary intervention
  • Prognosis
  • Receiver-operating characteristic curve analysis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Angeli, F., Verdecchia, P., Savonitto, S., Arraiz, G., Zaninotto, M., Broccatelli, A., ... Cavallini, C. (2015). Cystatin C and risk of mortality among patients undergoing percutaneous coronary intervention. EuroIntervention, 11(7), 757-764. https://doi.org/10.4244/EIJY15M05_08

Cystatin C and risk of mortality among patients undergoing percutaneous coronary intervention. / Angeli, Fabio; Verdecchia, Paolo; Savonitto, Stefano; Arraiz, Gustavo; Zaninotto, Martina; Broccatelli, Andrea; Cosma, Chiara; De Servi, Stefano; Sabino, Federico; Briguori, Carlo; Ambrosio, Giuseppe; Cavallini, Claudio.

In: EuroIntervention, Vol. 11, No. 7, 01.11.2015, p. 757-764.

Research output: Contribution to journalArticle

Angeli, F, Verdecchia, P, Savonitto, S, Arraiz, G, Zaninotto, M, Broccatelli, A, Cosma, C, De Servi, S, Sabino, F, Briguori, C, Ambrosio, G & Cavallini, C 2015, 'Cystatin C and risk of mortality among patients undergoing percutaneous coronary intervention', EuroIntervention, vol. 11, no. 7, pp. 757-764. https://doi.org/10.4244/EIJY15M05_08
Angeli F, Verdecchia P, Savonitto S, Arraiz G, Zaninotto M, Broccatelli A et al. Cystatin C and risk of mortality among patients undergoing percutaneous coronary intervention. EuroIntervention. 2015 Nov 1;11(7):757-764. https://doi.org/10.4244/EIJY15M05_08
Angeli, Fabio ; Verdecchia, Paolo ; Savonitto, Stefano ; Arraiz, Gustavo ; Zaninotto, Martina ; Broccatelli, Andrea ; Cosma, Chiara ; De Servi, Stefano ; Sabino, Federico ; Briguori, Carlo ; Ambrosio, Giuseppe ; Cavallini, Claudio. / Cystatin C and risk of mortality among patients undergoing percutaneous coronary intervention. In: EuroIntervention. 2015 ; Vol. 11, No. 7. pp. 757-764.
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AU - Zaninotto, Martina

AU - Broccatelli, Andrea

AU - Cosma, Chiara

AU - De Servi, Stefano

AU - Sabino, Federico

AU - Briguori, Carlo

AU - Ambrosio, Giuseppe

AU - Cavallini, Claudio

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N2 - Aims: We tested the prognostic value of cystatin C in patients with documented coronary artery disease (CAD) who underwent percutaneous coronary artery intervention (PCI). We also tested the hypothesis that the incremental predictive value of cystatin C on all-cause mortality was superior to that of glomerular filtration rate (GFR) by the Modification of Diet in Renal Disease (MDRD) formula. Methods and results: Included in the study were 2,757 patients (mean age 63 years, 77% men). Blood samples for cystatin C levels were collected immediately before PCI. During a median follow-up of two years, 114 patients died. In multivariable Cox analyses, after adjustment for several confounders, GFR (p=0.004) and cystatin C concentration (p<0.0001) were independent predictors of all-cause death. Cystatin C predicted all-cause death (c-statistic: 0.794) better than GFR estimate based on creatinine (c-statistic: 0.776, p=0.008 for comparison), and significantly reclassified 15% of patients into categories that reflected their actual likelihood of death more accurately (p=0.005). Adding cystatin C and GFR in the same multivariable survival model, only cystatin C level was a significant predictor of death. Conclusions: This study presents for the first time the incremental predictive value of cystatin C over the creatinine-based MDRD formula on all-cause mortality for CAD patients undergoing PCI.

AB - Aims: We tested the prognostic value of cystatin C in patients with documented coronary artery disease (CAD) who underwent percutaneous coronary artery intervention (PCI). We also tested the hypothesis that the incremental predictive value of cystatin C on all-cause mortality was superior to that of glomerular filtration rate (GFR) by the Modification of Diet in Renal Disease (MDRD) formula. Methods and results: Included in the study were 2,757 patients (mean age 63 years, 77% men). Blood samples for cystatin C levels were collected immediately before PCI. During a median follow-up of two years, 114 patients died. In multivariable Cox analyses, after adjustment for several confounders, GFR (p=0.004) and cystatin C concentration (p<0.0001) were independent predictors of all-cause death. Cystatin C predicted all-cause death (c-statistic: 0.794) better than GFR estimate based on creatinine (c-statistic: 0.776, p=0.008 for comparison), and significantly reclassified 15% of patients into categories that reflected their actual likelihood of death more accurately (p=0.005). Adding cystatin C and GFR in the same multivariable survival model, only cystatin C level was a significant predictor of death. Conclusions: This study presents for the first time the incremental predictive value of cystatin C over the creatinine-based MDRD formula on all-cause mortality for CAD patients undergoing PCI.

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