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

• Published in: The American heart journal 2012-11, Vol.164 (5), p.728-734
• Main Authors: Åkerblom, Axel, MD, Wallentin, Lars, MD, PhD, Siegbahn, Agneta, MD, PhD, Becker, Richard C., MD, Budaj, Andrzej, MD, PhD, Horrow, Jay, MD, Husted, Steen, MD, DSc, Katus, Hugo, MD, Claeys, Marc J., MD, PhD, Storey, Robert F., MD, DM, Åsenblad, Nils, PhLic, MSc, James, Stefan K., MD, PhD
• Format: Article
• Language: English
• Subjects: Acute Coronary Syndrome - blood; Acute Coronary Syndrome - drug therapy; Acute Coronary Syndrome - metabolism; Acute coronary syndromes; Adenosine - analogs & derivatives; Adenosine - therapeutic use; Age; Aged; Analysis of Variance; Biological and medical sciences; Biomarkers; Biomarkers - blood; Body mass index; Cardiology. Vascular system; Cardiovascular; Coronary heart disease; Cystatin C - blood; Cystatin C - metabolism; Diabetes; Female; Heart; Heart attacks; Heart failure; Humans; Kidney - drug effects; Kidney - metabolism; Kidney Function Tests; Male; Medical sciences; Middle Aged; Myocarditis. Cardiomyopathies; Platelet Aggregation Inhibitors - therapeutic use; Purinergic P2Y Receptor Antagonists - therapeutic use; Ratios; Risk Factors; Ticlopidine - analogs & derivatives; Ticlopidine - therapeutic use; Treatment Outcome; Variables
• ISSN: 0002-8703; 1097-6744; 1097-6744
• DOI: 10.1016/j.ahj.2012.08.017

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.