WFRF:(Claeys M)
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Outcome and causes of renal deterioration evaluated by serial cystatin C measurements in acute coronary syndrome patients : Results from the PLATelet inhibition and patient Outcomes (PLATO) study
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- Åkerblom, Axel (author)
- Uppsala universitet,Uppsala kliniska forskningscentrum (UCR),Kardiologi
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- Wallentin, Lars (author)
- Uppsala universitet,Uppsala kliniska forskningscentrum (UCR),Kardiologi
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- Siegbahn, Agneta (author)
- Uppsala universitet,Koagulation och inflammationsvetenskap
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- Becker, R. C. (author)
- Budaj, A. (author)
- Horrow, J. (author)
- Husted, S. (author)
- Katus, H. (author)
- Claeys, M. J. (author)
- Storey, R. F. (author)
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- (creator_code:org_t)
- Elsevier BV, 2012
- 2012
- English.
- In: American Heart Journal. - : Elsevier BV. - 0002-8703 .- 1097-6744. ; 164:5, s. 728-734
- Journal article (peer-reviewed)
Abstract
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- 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 and 0.86 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.
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- Åkerblom, Axel
- Wallentin, Lars
- Siegbahn, Agneta
- Becker, R. C.
- Budaj, A.
- Horrow, J.
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- Husted, S.
- Katus, H.
- Claeys, M. J.
- Storey, R. F.
- Åsenblad, Nils
- James, Stefan K.
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