Department of Cardiology, Chinese People's Liberation Army General Hospital, Beijing, China,
Department of Cardiology, Hainan Branch of Chinese People's Liberation Army General Hospital, Sanya, Hainan, China.
Clin Interv Aging. 2018 Jul 3;13:1201-1209. doi: 10.2147/CIA.S151211. eCollection 2018.
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).
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.
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 (<0.05), and were significantly different according to the tertile concentration of Cys C of AMI patients (<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.
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.
本研究旨在评估胱抑素 C（Cys C）和同型半胱氨酸（Hcy）联合应用对 >80 岁急性心肌梗死（AMI）患者不良事件的预测价值。
该分析纳入了 2006 年 1 月至 2012 年 12 月在中国行冠状动脉造影检查的 753 例 >80 岁胸痛患者。采用 Kaplan-Meier 法评估生存和主要不良心脏事件（MACE）发生率。多变量 Cox 回归分析用于识别死亡率预测因子。受试者工作特征曲线分析用于预测全因死亡率的 Cys C 和 Hcy 截断值。
随访时间为 40-116 个月（中位数 63 个月；四分位距 51-74 个月）。AMI 患者的长期生存率和无事件生存率明显低于不稳定型心绞痛患者（<0.05），且根据 AMI 患者 Cys C 的三分位浓度存在显著差异（<0.01）。Cys C 和 Hcy 是 AMI 患者长期全因死亡（优势比[OR] =3.72[2.27-6.09]；OR =1.59[1.04-2.61]）和 MACE（OR =2.83[1.82-4.40]；OR =1.09[1.04-1.21]）的独立危险因素。Cys C 的预测截断值为 1.815mg/L（82.8%，86.4%），Hcy 的预测截断值为 15.06μmol/L（84.4%，83.1%）。联合使用两种生物标志物的截断值可进一步提高全因死亡率的敏感性和特异性。
Cys C 是 >80 岁 AMI 患者长期全因死亡和 MACE 的强独立预测因子。联合使用 Cys C 和 Hcy 可进一步提高预测准确性。
