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.

Abstract

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.

• Authors: Axel Akerblom, Lars Wallentin, Agneta Siegbahn, Richard C Becker, Andrzej Budaj, Jay Horrow, Steen Husted, Hugo Katus, Marc J Claeys, Robert F Storey, Nils Asenblad, Stefan K James
• Journal: American heart journal (Am Heart J) Vol. 164 Issue 5 Pg. 728-34 (Nov 2012) ISSN: 1097-6744 [Electronic] United States
• PMID: 23137503 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2012 Mosby, Inc. All rights reserved.

Chemical References

• Biomarkers
• Cystatin C
• Platelet Aggregation Inhibitors
• Purinergic P2Y Receptor Antagonists
• Clopidogrel
• Ticagrelor
• Adenosine
• Ticlopidine

Topics

• Acute Coronary Syndrome (blood, drug therapy, metabolism)
• Adenosine (analogs & derivatives, therapeutic use)
• Aged
• Analysis of Variance
• Biomarkers (blood)
• Clopidogrel
• Cystatin C (blood, metabolism)
• Female
• Humans
• Kidney (drug effects, metabolism)
• Kidney Function Tests
• Male
• Middle Aged
• Platelet Aggregation Inhibitors (therapeutic use)
• Purinergic P2Y Receptor Antagonists (therapeutic use)
• Risk Factors
• Ticagrelor
• Ticlopidine (analogs & derivatives, therapeutic use)
• Treatment Outcome