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Title
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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
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Author
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Institution/Organisation
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PLATO Investigators
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Abstract
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| 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. (Am Heart J 2012;164:728-34.) |
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Language
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English
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Source (journal)
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American heart journal. - St. Louis, Mo.
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Publication
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St. Louis, Mo.
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2012
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ISSN
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0002-8703
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DOI
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10.1016/J.AHJ.2012.08.017
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Volume/pages
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164
:5
(2012)
, p. 728-734
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ISI
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000310783100015
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Full text (Publisher's DOI)
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Full text (publisher's version - intranet only)
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