Cystatin C as a Predictor of Major Adverse Cardiovascular Event in Patients with Acute Myocardial Infarction Without Cardiogenic Shock and Renal Impairment After Coronary Intervention

Abstract

Purpose To prove that cystatin C is a predictor of major adverse cardiovascular events (MACE) after percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI), either with ST-segment Elevation (AMI-EST) or without ST-segment elevation (AMI-NEST), without cardiogenic shock or renal impairment. Patient and Methods This was an observational cohort study. Samples were obtained from AMI patients who underwent PCI between February 2022 and March 2022 at the Intensive Cardiovascular Care Unit. Cystatin C levels were measured before PCI. MACE were observed within 6 months. Comparisons between normally distributed continuous data were performed using the t -test; Mann–Whitney test was used for non-normally distributed data. Categorical data were compared using the chi-squared test. The cut-off point of cystatin C levels to predict MACE was analyzed using Receiver Operating Characteristics (ROC). Results The participants were 40 AMI patients, consisting of 32 patients (80%) with AMI-EST and eight patients (20%) diagnosed with AMI-NEST, who were evaluated for the occurrence of MACE within 6 months after PCI. Ten patients (25%) developed MACE during follow-up [(MACE (+)], and the rest were in the MACE (-) group. Cystatin C levels were significantly higher in the MACE (+) group (p=0.021). ROC analysis revealed a cystatin C level of 1.21 mg/dL; cystatin C > 1.21 is associated with MACE risk, showing a significant relationship with the odds ratio value reaching 26.00, with 95% CI (3.99–169.24). Conclusion Cystatin C level is an independent predictor of MACE in patients with AMI without cardiogenic shock or renal impairment after PCI.

Limitations in the Use of Cystatin C as a Predictor of Major Adverse Cardiovascular Events: Consideration of Non-Renal Factors [Letter]

“…We reviewed Wasyanto et al’s article titled “Cystatin C as a Predictor of Major Adverse Cardiovascular Event in Patients with Acute Myocardial Infarction Without Cardiogenic Shock and Renal Impairment After Coronary Intervention” 1 in the International Journal of General Medicine and applaud the authors on a successful publication. The study involved 40 patients with acute myocardial infarction (AMI) and examined the association between cystatin C levels and major adverse cardiovascular events (MACE) over a 6-month follow-up.…”

“…Similarly, obesity is linked to elevated cystatin C levels due to chronic low-grade inflammation in adipose tissue, which triggers increased production and release of cystatin C. Insulin resistance, prevalent in obesity, also contributes to higher cystatin C levels. 3 Furthermore, patients presenting with hyperthyroidism also display elevated base Cystatin C levels, attributed to the altered production rate of Cystatin C instead of a change in glomerular clearance, 4 , 5 a confounding factor that Wasyanto et al 1 did not take into account.…”