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
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 cystati...
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| Main Authors: | , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
2012
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| In: |
American heart journal
Year: 2012, Volume: 164, Issue: 5, Pages: 728-734 |
| ISSN: | 1097-6744 |
| DOI: | 10.1016/j.ahj.2012.08.017 |
| Online Access: | Verlag, Volltext: http://dx.doi.org/10.1016/j.ahj.2012.08.017
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| Author Notes: | Axel Akerblom, Lars Wallentin, Agneta Siegbahn, Richard C. Becker, Andrzej Budaj, Jay Horrow, Steen Husted, Hugo Katus, Marc J. Claeys, Robert F. Storey, Nils Asenblad, and Stefan K. James |
| Summary: | 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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| Item Description: | Gesehen am 09.04.2018 |
| Physical Description: | Online Resource |
| ISSN: | 1097-6744 |
| DOI: | 10.1016/j.ahj.2012.08.017 |