Research On The Relationship Between Serum Cystatin C Levels And ACS Severity

Objective:This study is designed to observe serum cystatin C level in patients with different types of acute coronary syndromes(ACS),to explore the relationship between serum Cys C and coronary Gensini score in patients with ACS and explore the value of serum CysC in forecasting the severity of coronary artery disease.The association between CysC and GRACE risk scores in patients with non-ST-segment elevation acute coronary syndrome(NSTE-ACS)is also detected.It may provide the evidence that serum Cys C could be a new index for diagnosis and prognosis of ACS.Methods:268 Patients with or without ACS who underwent coronary angiography(CAG)in the department of cardiology of Shaanxi People’s Hospital from January 2016 to October 2016 were recruited.268 Patients were divided into ACS group(n=219)and control group(n=49)according to CAG results.The ACS group was divided into ST-segment elevation myocardial infarction group(n=68,STEMI),non-ST-segment elevation myocardial infarction group(n=53,NSTEMI)and unstable angina group(n=98,UA).General clinical data and biochemical indicators such as AST,ALT,TG,TC,LDL-C,HDL-C,apo-AI,apo-B,BUN,SCR,URC,Fib,cTnI and CK-MB of all groups were collected.The degree of coronary artery stenosis in patients with ACS was evaluated by Gensini scoring system.ACS group was divided into mild stenosis group(1-30 points),moderate stenosis group(31-90 points)and severe stenosis group(≥91points)according to the Gensini score.Patients with ACS were divided into single diseased coronary vessel group,double diseased coronary vessels group and many diseased coronary vessels group according to CAG results.GRACE risk scoring system was used to assess the risk of patients with ACS.Patients with NSTE-ACS were divided into low risk group(1-108 points),moderate risk group(109-140 points)and high risk group(141-372 points)according to the GRACE risk score.The level of serum cystatin C was compared and the correlation was analyzed among every group.Results:(1)Serum CysC level of STEMI group,NSTEMI group and UA group were significantly higher than those of the control group(STEMI group vs NSTEMI group vs UA group vs control group,1.18±0.37mg/L vs 1.19±0.40mg/L vs 1.09±0.21mg/L vs0.94±0.19mg/L,P<0.001).(2)Serum CysC level of single diseased coronary vessel group,double diseased coronary vessels group and many diseased coronary vessels group were significantly higher than those of the control group(single diseased coronary vessel group vs double diseased coronary vessels group vs many diseased coronary vessels group vs control group,1.09±0.18mg/L vs 1.18±0.22mg/L vs 1.46±0.25mg/L vs 0.94±0.19mg/L,P<0.001).(3)Serum CysC level of mild stenosis group,moderate stenosis group and severe stenosis group were significantly higher than those of the control group(mild stenosis group vs moderate stenosis group vs severe stenosis group vs control group,1.12±0.18mg/L vs 1.25±0.27mg/L vs 1.47±0.26mg/L vs 0.94±0.19mg/L,P<0.001).(4)Cys C was positively correlated with Gensini score in patients with ACS(r=0.413(P < 0.001);Serum Cys C level was positively correlated with age,diabetes,carotid atherosclerosis,smoking index,heart rate,BMI,Fib,ALT,AST,BUN,SCR,LDL-C,apo-B,cTnI and CK-MB respectivlely,and the correlation coefficients were 0.249,0.254,0.206,0.287,0.151,0.178,0.327,0.179,0.301,0.202,0.266,0.125,0.240,0.536,0.519respectivlely(P < 0.05).(5)There was an independent linear correlation between serum CysC level and Gensini score of patients with ACS(the standardized partial regression coefficient was0.285,P < 0.001).(6)Serum CysC levels in patients with NSTE-ACS with low risk group,moderate risk group and high risk group were higher than that of the control group(low risk groupvs moderate risk group vs high risk group vs control group,1.03±0.23mg/L vs 1.13±0.22mg/L vs 1.27±0.45mg/L vs 0.94±0.19mg/L,P<0.001).(7)Cys C level was positively correlated with GRACE risk score in patients with NSTE-ACS(r=0.508,P < 0.001);The GRACE risk score of patients with NSTE-ACS was positively correlated with smoking index,BMI,Fib,ALT,AST,SCR,TG,apo-B,cTnI and CK-MB respectivlely,and the correlation coefficients were 0.317,0.209,0.373,0.299,0.553,0.238,0.131,0.219,0.796,0.685 respectivlely(P < 0.05).(8)There was an independent linear correlation between serum CysC level and the GRACE risk score in patients with NSTE-ACS(the standardized partial regression coefficient was 0.365,P < 0.001).Conclusion:(1)Serum CysC level in patients with different types of acute coronary syndromes were significantly increased.There was an independent linear correlation between the level of serum CysC and the Gensini score of patients with ACS.Serum CysC levels could not only reflect the severity of coronary artery disease in patients with ACS but also had an effect on evaluating the severity of those patients.(2)Serum Cys C level significantly elevated in patients with NSTE-ACS.Serum Cys C and GRACE risk score in patients with NSTE-ACS showed an independent linear correlation.Serum Cys C could reflect the risk of patients with NSTE-ACS and might provide a new way to forecast the risk of those patients.(3)There was a correlation between serum cystatin C levels and ACS severity.Serum CysC level might serve as a new laboratory indicator for the diagnosis and prognosis of ACS.