经皮冠状动脉介入治疗患者血清胱抑素C水平与主要不良心血管事件的关联
Association of serum cystatin C level and major adverse cardiovascular events in patients with percutaneous coronary intervention.
作者信息
Xiao Zhibin, Riletu Aoge, Yan Xiaoyu, Meng Qi, Zhang Weiru, Zhang Na, Ma Chi, Guo Xin, Han Jiatong, Nie Huijuan, Deng Hui, Liu Jing, Chen Jianping, Dong Yu, Liu Tianlong
机构信息
Department of Clinical Pharmacy, College of Pharmacy, Inner Mongolia Medical University, Hohhot, China.
Department of Pharmacy, Inner Mongolian International Mongolian Hospital, Hohhot, China.
出版信息
Cardiovasc Diagn Ther. 2024 Aug 31;14(4):621-629. doi: 10.21037/cdt-23-482. Epub 2024 Aug 16.
BACKGROUND
Recurrent acute myocardial infarction requiring unplanned percutaneous coronary intervention (PCI) is one of the major adverse cardiovascular events (MACEs) in patients with acute coronary syndrome (ACS) after PCI. There is a continuing controversy about the association between serum cystatin C, a biomarker for the evaluation of renal function, and the prognosis of ACS patients following PCI. The retrospective study evaluated the association between serum cystatin C level and MACE in ACS patients after PCI.
METHODS
Data were retrieved for 330 patients with ACS for primary PCI in a single center. Serum cystatin C levels were measured before PCI. All patients underwent regular follow-ups after PCI, and the studied endpoint was MACE, defined as the need for a repeat revascularization in the heart. The predictive value of serum cystatin C for MACE was analyzed using univariate and multivariate analysis. Restricted cubic spline (RCS) analysis was applied to evaluate the dose-response relationship between serum cystatin C level and MACE in ACS patients following PCI.
RESULTS
After a median follow-up of 63 months (range, 1-148 months), 121 of the 330 patients experienced MACE. Compared to patients who did not have MACE, patients who had MACE showed a significant decrease in serum cystatin C levels (0.99±0.32 1.15±0.78 mg/L, P=0.03). In multivariate regression analysis, serum cystatin C level was an independent risk factor for MACE. According to the serum cystatin C level, patients were divided into 4 categories, Cox regression analysis illustrated that the second quartile of serum cystatin C level indicated an increased risk of MACE in patients with PCI for primary ACS compared to the highest quartile [Q2: adjusted hazard ratio (HR) =2.109; 95% confidence interval (CI): 1.193-3.727; P=0.01]. RCS analysis showed a significant U-shaped dose-response relationship between cystatin C level and MACE in patients with PCI for ACS (P for non-linearity =0.004).
CONCLUSIONS
These results indicated an association between serum cystatin C level and post-PCI MACE in ACS patients.
背景
复发性急性心肌梗死需要进行非计划性经皮冠状动脉介入治疗（PCI）是急性冠状动脉综合征（ACS）患者PCI术后主要不良心血管事件（MACE）之一。血清胱抑素C作为评估肾功能的生物标志物，其与PCI术后ACS患者预后之间的关系一直存在争议。这项回顾性研究评估了PCI术后ACS患者血清胱抑素C水平与MACE之间的关系。
方法
检索了单中心330例行初次PCI的ACS患者的数据。在PCI术前测量血清胱抑素C水平。所有患者在PCI术后均接受定期随访，研究终点为MACE，定义为心脏需要再次血运重建。采用单因素和多因素分析血清胱抑素C对MACE的预测价值。应用限制立方样条（RCS）分析评估PCI术后ACS患者血清胱抑素C水平与MACE之间的剂量反应关系。
结果
中位随访63个月（范围1 - 148个月）后，330例患者中有121例发生MACE。与未发生MACE的患者相比，发生MACE的患者血清胱抑素C水平显著降低（0.99±0.32对1.15±0.78 mg/L，P = 0.03）。在多因素回归分析中，血清胱抑素C水平是MACE的独立危险因素。根据血清胱抑素C水平，将患者分为4组，Cox回归分析表明，与最高四分位数相比，血清胱抑素C水平的第二个四分位数表明初次ACS行PCI患者发生MACE的风险增加[Q2：调整后风险比（HR）=2.109；95%置信区间（CI）：1.193 - 3.727；P = 0.01]。RCS分析显示，ACS行PCI患者中，胱抑素C水平与MACE之间存在显著的U型剂量反应关系（非线性P = 0.004）。
结论
这些结果表明ACS患者血清胱抑素C水平与PCI术后MACE之间存在关联。
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