The Clinical Value Of Cystatin C In Non ST Segment Elevation Acute Coronary Syndrome

Background: Acute coronary syndrome is a clinical syndrome whose pathological basisis coronary artery occlusion or partial occlusion induced by secondary thrombosiswhich is followed by atherosclerotic plaque rupture. It is a common cardiovascularemergency with high mortality, and also a public health issue affecting human’s physicaland mental health all over the world recently. According to the shift of ST segment,Acute coronary syndrome is divided into non ST-elevation acute coronary syndromesand ST-elevation myocardial infarction. Large-scale retrosprospective study showed thatcoronary heart disease incidence is promoted by several risk factors such as age, highblood pressure, blood lipid metabolic abnormalities, diabetes mellitus and smokinghistory. Currently, local and foreign medical experts have introduced some new factorswhich affect coronary heart disease mortality.The2007European non ST segmentacute coronary syndromes guidelines formally added cystatin C as a risk stratification,and points out that it is related to long-term mortality and it can be used to predictrecurrence of myocardial infarction (MI).Objective: Detect serum CystatinC expression level of patients with non ST segmentelevation acute coronary syndrome, determine the role of Cys C in the various acutecoronary syndrome types, coronary artery plaque and multivessel lesion severity, andthe clinical significance of patients’ prognosis within18months.Selection methods: Between November2011and November2012, the department ofCardiology analysed240patients with acute coronary syndrome. This retrospective study included180patients with non ST segment elevation acute myocardial infarction(NSTEAMI), among which90patients with unstable angina (UA),90patients with nonST segment elevation acute myocardial infarction(NSTEMI). The control groupincluded60patients who were admitted due to chest pain, chest tightness and in whomcoronary arteriography reveals an anatomically normal patent structure. We analysedthe data of these groups, including the biochemical paraeters within24hours. In themain control group, the serum cystatin C level was determined throughImmune-enhancing nephelometry, whereas in the control group, the admission timeserum level of Cystain C was recorded. By analysing coronary angiography records, theextent and location of coronary artery disease and by using Gensini scoring system forquantitative assessment of acute non-ST segment elevation acute coronary stenosis inpatients with coronary artery disease and its complexity, acute NSTEMI patients weredivided into univascular, bivascular and trivascular type. By comparing Cystatin Cserum level and Gensini score difference between the NSTEMI and UA group, a linearrelationship was observed with Gensini score among the non-ST segment elevationacute myocardial infarction and unstable angina group. Based on serum Cystatin Cmedium value of0.94, the sector dichotomy was divided into B1, B2groups. Afterdischarge, the two groups were monitored for18months. The main cardiovascularadverse events included recurrent angina, recurrent myocardial infarction, heart failureor sudden cardiac arrest. The statistical difference between the two groups and theclinical prognostic value of serum CystatinC in NSTEMI patients were analysed.Results:1. Serum CysC multivariate linear regression equation: CysC=1.300-0.006GFR+0.610Cr+0.004age. cys C with age, creatinine were positivelycorrelated (r>0, P <0.05), CysC and glomerular filtration rate was negatively correlatedwith a correlation coefficient R=-0.006, PCysC with TC, LDL, TG, FBG levels werenot significantly correlated (P>0.05)2. UA group, NSTEMI group, STEMI group, the control group, serum Cys C levelswere:(0.99±0.25) mg/L,(1.11±0.26) mg/L,(0.76±0.29) mg/L,(0.91±0.23) mg /L. Serum Cys C level UA and NSTEMI group were higher than that of control group,the difference was statistically significant (P <0.05)3. Non-ST segment elevation acute coronary syndromes tivascular lesion CysC mean(1.12±0.28) mg/were higher than univascular lesion group (0.87±0.31) mg/L,bivascular lesion group (0.89±0.32) mg/L, the difference was statistically significant(P <0.05), but the univascular and bivascular lesion groups parameters’(P>0.05)differences were not statistically significant.In patients with unstable angina, Cystatin C level reflects the severity of vascularlesions while Gensini score shows positive linear correlation. NSTEMI patients’Cystatin C serum level and Gensini score were critically positively correlated.4. Based on serum Cystatin C medium value of0.94, the sector dichotomy was dividedinto B1, B2groups. After discharge, the two groups were monitored for18months.Descriptive data within18months after vascular adverse events listed fourfold table2test,2=4.767，P value=0.029, the difference is statistically significant.Conclusion:1. Serum Cystatin-C level is associated with the type of acute coronarysyndrome; NSTEMI mean is significantly higher.2. Serum Cys-C levels and the severity of coronary artery disease in patients withunstable angina bear a positive linear correlation; available data suggests that serumCystatin C levels may be high for some NSTEMI trivascular lesions.3. There is a high correlation between adverse cardiovascular events within18monthsof an episode of NSTEMI and high levels of CysC. Serum CystatinC is an importantfactor for prediction of coronary heart disease (CHD) and its poor prognosis; the rise ofserum CystatinC correlates with the occurrence of adverse cardiovascular events.