Document Detail

Cystatin C for enhancement of risk stratification in non-ST elevation acute coronary syndrome patients with an increased troponin T.
MedLine Citation:
PMID:  19359536     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: We assessed the value of cystatin C for improvement of risk stratification in patients with non-ST elevation acute coronary syndrome (nSTE-ACS) and increased cardiac troponin T (cTnT), and we compared the long-term effects of an early invasive treatment strategy (EIS) with a selective invasive treatment strategy (SIS) with regard to renal function. METHODS: Patients (n = 1128) randomized to an EIS or an SIS in the ICTUS trial were stratified according to the tertiles of the cystatin C concentration at baseline. The end points were death within 4 years and spontaneous myocardial infarction (MI) within 3 years. RESULTS: Mortality was 3.4%, 6.2%, and 13.5% in the first, second, and third tertiles, respectively, of cystatin C concentration (log-rank P < 0.001), and the respective rates of spontaneous MI were 5.5%, 7.5%, and 9.8% (log-rank P = 0.03). In a multivariate Cox regression analysis, the cystatin C concentration in the third quartile remained independently predictive of mortality [hazard ratio (HR), 2.04; 95% CI, 1.02-4.10; P = 0.04] and spontaneous MI (HR, 1.95; 95% CI, 1.05-3.63; P = 0.04). The mortality rate in the second tertile was lower with the EIS than with the SIS (3.8% vs 8.7%). In the third tertile, the mortality rates with the EIS and the SIS were, respectively, 15.0% and 12.2% (P for interaction = 0.04). Rates of spontaneous MI were similar for the EIS and the SIS within cystatin C tertiles (P for interaction = 0.22). CONCLUSIONS: In patients with nSTE-ACS and an increased cTnT concentration, mild to moderate renal dysfunction is associated with a higher risk of death and spontaneous MI. Use of cystatin C as a serum marker of renal function may improve risk stratification.
Fons Windhausen; Alexander Hirsch; Johan Fischer; P Marc van der Zee; Gerard T Sanders; Jan P van Straalen; Jan Hein Cornel; Jan G P Tijssen; Freek W A Verheugt; Robbert J de Winter;
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2009-04-09
Journal Detail:
Title:  Clinical chemistry     Volume:  55     ISSN:  1530-8561     ISO Abbreviation:  Clin. Chem.     Publication Date:  2009 Jun 
Date Detail:
Created Date:  2009-05-29     Completed Date:  2009-06-19     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9421549     Medline TA:  Clin Chem     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1118-25     Citation Subset:  IM    
Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands.
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MeSH Terms
Acute Coronary Syndrome / blood*,  therapy
Coronary Angiography
Cystatin C / blood*
Middle Aged
Risk Assessment
Troponin T / blood*
Reg. No./Substance:
0/Cystatin C; 0/Troponin T

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