La cistatina C aporta más información que otros parámetros de función renal en la estratificación del riesgo de los pacientes con síndrome coronario agudo

Métodos Estudiamos prospectivamente a 203 pacientes ingresados por síndrome coronario agudo. Se realizó una determinación analítica a las 24 h del ingreso que incluía creatinina, cistatina C, hemograma, colesterol total y fraccionado y marcadores de necrosis miocárdica. Se estimó la tasa de filtrado glomerular mediante la ecuación MDRD. Se compararon dos grupos según las concentraciones séricas de cistatina C (> 0,95 y < 0,95 mg/l). Se llevó a cabo un seguimiento medio de 151 días. Resultados Noventa (44,3%) pacientes tenían cistatina C ≤ 0,95 mg/l y 113 (55,7%), > 0,95 mg/l. Aquellos con cistatina C > 0,95 mg/l presentaron peor evolución hospitalaria con más insuficiencia cardiaca (el 51,3 frente al 13,3%; p = 0,001), mayor mortalidad hospitalaria (el 17,6 frente al 3,3%; p = 0,001) y durante el seguimiento (el 22 frente al 5,6%; p = 0,001). En un modelo multivariable ajustado por edad, fracción de eyección, troponina I y proteína C reactiva ultrasensible, la cistatina C demostró ser el predictor independiente más potente de complicaciones cardiovasculares (RR = 1,91; intervalo de confianza del 95%, 1,03-3,53). Los pacientes con cistatina C > 0,95 y tasa de filtración > 60/ml/1,73 m 2 presentaron mayor mortalidad hospitalaria (el 10,2 frente al 3,9%; p = 0,001). Conclusiones La determinación de cistatina C en el síndrome coronario agudo de alto riesgo podría ser un buen elemento clínico en la estratificación de su riesgo durante la hospitalización, en particular en pacientes con filtrado glomerular normal. Introduction and objectives The protein cystatin C has a stable plasma concentration and is eliminated exclusively by the kidneys. The aim of this study was to determine the prognostic value of cystatin C in patients with acute coronary syndrome (ACS). Methods The prospective study included 203 hospitalized ACS patients. Clinical evaluation during the first 24 hours of hospitalization included a hemogram and measurement of creatinine, cystatin C, total and fractionated cholesterol and markers of myocardial necrosis. The glomerular filtration rate (GFR) was estimated using the MDRD (Modification of Diet in Renal Disease) equation. A comparison was made between two groups of patients divided according to a serum cystatin-C level above or below 0.95 mg/L. The mean follow-up period was 151 days. Results In total, 90 patients (44.3%) had a cystatin-C level ≤0.95 mg/L and 113 (55.7%) had a level >0.95 mg/L. Those with a cystatin-C level >0.95 mg/L had poorer in-hospital outcomes, including more frequent heart failure (51.3% vs. 13.3%; P =.001) and higher in-hospital mortality (17.6% vs. 3.3%; P =.001), as well as higher mortality throughout follow-up (22.0% vs. 5.6%; P =.001). Multivariate analysis adjusted for age, ejection fraction and troponin-I and high-sensitivity C-reactive protein concentrations showed that cystatin C was the most powerful independent predictor of a cardiovascular event (relative risk=1.91; 95% confidence interval, 1.03-3.53). Patients with a GFR >60 mL/1.73 m 2 and a cystatin-C level >0.95 mg/L had higher in-hospital mortality (10.2% vs. 3.9%; P =.001). Conclusions Measurement of cystatin C in high-risk ACS patients may be clinically useful for risk stratification during hospitalization, particularly in those with a normal GFR. Palabras clave Cistatina C Síndrome coronario agudo Insuficiencia cardiaca Proteína C reactiva Key words Cystatin C Acute coronary syndrome Heart failure C-reactive protein Abreviaturas MDRD Modification of Diet in Renal Disease SCA síndrome coronario agudo TpI troponina I Bibliografía 1. R. Carda J.A. De Agustín M.C. Manzano J.C. García-Rubira A. Fernández-Ortiz I. 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