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Quantification of Renal Function and Cardiovascular Mortality in Patients Admitted to the Emergency Department with Suspected Acute Coronary Syndromes: Results from the TRAPID-AMI Study
Friedrich Alexander Univ, Inst Biomed Aging.
Paracelsus Med Univ, Gen Hosp Nuremberg, Inst Clin Chem Lab Med & Transfus Med.
Univ Hosp Heidelberg, Dept Cardiol.
Luzerner Kantonsspital, Emergency Dept.
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2017 (English)In: Clinical Laboratory, ISSN 1433-6510, Vol. 63, no 9, p. 1457-1466Article in journal (Refereed) Published
Abstract [en]

Background: Increases in the novel serum marker cystatin C are detectable much earlier in the course of chronic kidney disease (CKD) even when levels of serum creatinine are still in the normal range. A major factor causing a decrease in serum creatinine is increasing age. Patients with CKD are more likely to develop cardiovascular disease (CVD) than a healthy population and to suffer premature deaths from CVD related to CKD. The aim of this study was to investigate whether cystatin C, serum creatinine, and estimated glomerular filtration rate (eGFR) predict cardiovascular mortality in patients admitted to the emergency department (ED) with suspected acute coronary syndromes (ACS).

Methods: In 1,282 patients (mean age 62 15 years, 477 women, 805 men) with suspected ACS, baseline cystatin C concentrations, serum creatinine, and estimated glomerular filtration rate (eGFR) were measured at the ED. Clinical assessment and serial high sensitivity cardiac troponin T (hs-cTnT) measurements were used for the diagnosis of ACS. Seventeen cardiovascular deaths were registered during a median follow-up of 365 days.

Results: HRs from univariate Cox regression models for each of the potential biomarkers were 12.02 (95% CI 5.10 - 28.34) for cystatin C, 4.53 (1.75 - 11.70) for serum creatinine, and 0.97 (0.96 - 0.99) for eGFR. All three biomarkers showed a significant association with cardiovascular mortality in univariate analyses. The HRs from a model with all three potential biomarkers were 59.21 (95% CI 9.69 - 361.76) for cystatin C, 0.08 (0.01 - 0.58) for serum creatinine, and 0.98 (0.96 - 1.01) for eGFR. The risk association was significant for ln (cystatin C) and ln (serum creatinine).

Conclusions: Results of this prospective study show that the quantification of renal function using cystatin C is useful for predicting cardiovascular mortality in patients with suspected ACS at the ED.

Place, publisher, year, edition, pages
2017. Vol. 63, no 9, p. 1457-1466
Keywords [en]
acute coronary syndrome, aged, prognosis, cystatin C, creatinine, chronic kidney disease, glomerular filtration rates
National Category
Biomedical Laboratory Science/Technology
Identifiers
URN: urn:nbn:se:uu:diva-335768DOI: 10.7754/Clin.Lab.2017.170326ISI: 000410465900016PubMedID: 28879725OAI: oai:DiVA.org:uu-335768DiVA, id: diva2:1166509
Available from: 2017-12-15 Created: 2017-12-15 Last updated: 2017-12-15Bibliographically approved

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