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Prognostic ability of cystatin C and homocysteine plasma levels for long-term outcomes in very old acute myocardial infarction patients

Authors Fu Z, Yang X, Shen M, Xue H, Qian G, Cao F, Guo J, Dong W, Chen Y

Received 8 September 2017

Accepted for publication 17 April 2018

Published 3 July 2018 Volume 2018:13 Pages 1201—1209

DOI https://doi.org/10.2147/CIA.S151211

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Andrew Yee

Peer reviewer comments 3

Editor who approved publication: Dr Wu


Zhenhong Fu,1,* Xia Yang,1,* Mingzhi Shen,2,* Hao Xue,1,* Geng Qian,1 Feng Cao,1 Jun Guo,1 Wei Dong,1 Yundai Chen1

1Department of Cardiology, Chinese People’s Liberation Army General Hospital, Beijing, China; 2Department of Cardiology, Hainan Branch of Chinese People’s Liberation Army General Hospital, Sanya, Hainan, China

*These authors contributed equally to this work

Background and aims: This study sought to evaluate the prognostic powers of combined use of cystatin C (Cys C) and homocysteine (Hcy) at predicting adverse events of patients >80 years old with acute myocardial infarction (AMI).
Patients and methods: The analysis involved 753 patients >80 years old undergoing coronary angiography for chest pain in China from January 2006 to December 2012. Kaplan–Meier method was used for survival and major adverse cardiac events (MACE) rates. Multivariate Cox regression was performed to identify mortality predictors. Receiver operating characteristic curve analysis was performed to predict the cutoff values of Cys C and Hcy for all-cause mortality.
Results: The duration of follow-up was 40–116 months (median, 63 months; interquartile range, 51–74 months). The long-term survival and event-free survival rates of AMI patients were significantly lower than those of unstable angina pectoris patients (P<0.05), and were significantly different according to the tertile concentration of Cys C of AMI patients (P<0.01). Cys C and Hcy were independent risk factors for long-term all-cause mortality (odds ratio [OR] =3.72 [2.27–6.09]; OR =1.59 [1.04–2.61]) and MACE (OR =2.83 [1.82–4.40]; OR =1.09 [1.04–1.21]) of AMI patients. The predictive cutoff value of Cys C was 1.815 mg/L (82.8%, 86.4%) and that of Hcy was 15.06 µmol/L (84.4%, 83.1%) in AMI patients. Combined use of both biomarker’s cutoff values further increased the sensitivity and specificity of all-cause mortality.
Conclusion: Cys C is a strong independent predictor of long-term all-cause death and MACE in very old AMI patients. The combined use of Cys C and Hcy further improves the predictive accuracy.

Keywords: cystatin C, homocysteine, very old, acute myocardial infarction, prognosis

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