Cystatin C-Based Renal Function in Predicting the Long-Term Outcomes of Chronic Total Occlusion After Percutaneous Coronary Intervention.
Cystatin C-Based Renal Function in Predicting the Long-Term Outcomes of Chronic Total Occlusion After Percutaneous Coronary Intervention.
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DOI：
10.3389/fcvm.2020.586181
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发表时间：
2020
影响因子：
3.6
通讯作者：
Zhuo XZ
中科院分区：
文献类型：
--
作者：
Li B;Rong J;Wang B;Gao K;Wen X;Li H;Cheng L;Hua YM;Li S;Jian Z;Zhang Y;Huang H;Pan Y;Wu Y;Zhuo XZ
在慢性全闭塞（CTO）晚期动脉粥样硬化患者接受的经皮冠状动脉介入治疗（PCI）中，通过各种生物标志物预测不良心血管事件的肾功能尚未得到很好的鉴定。我们的目的是确定基于血清胱抑素c估计肾小球滤过率（eGFR）是否可以改善CTO病变行PCI患者的预测价值，与基于多种肌酐的肾功能估计相比。671例接受CTO PCI的患者被回顾性纳入研究。eGFR分别通过修改中国肾脏疾病方程（cMDRD）和慢性肾脏疾病流行病学合作（CKD-EPI）方程中的饮食来计算。然后，根据基于eGFR的标准KDIGO肾脏分期将该队列分为三组。主要终点是全因死亡率，次要终点是心源性死亡。引人注目的是，基于胱抑素c的eGFR表现出更好的表现，在接受者工作特征（ROC）曲线下的面积更大（全因死亡率为0.73，心源性死亡分别为0.73），并且在四个eGFR方程中，对肾脏水平无不良事件的生存率有更好的评估。与其他公式计算的eGFR相比，基于血清胱抑素c的eGFR对全因死亡率（校正HR 3.6, 95% CI 1.6-8.1, P = 0.002）和心源性死亡（校正HR 2.9, 95% CI 1.0-8.1, P = 0.028）均显示出最高的预后价值。此外，基于胱抑素c的eGFR显著改善了事件的风险重分类，净重分类改善值和综合判别改善值都很高。本研究可能证明，在接受PCI的CTO患者中，基于胱抑素c的eGFR比其他方程更能预测全因死亡率和心源性死亡。
Renal function estimated by various biomarkers predicting for adverse cardiovascular events has not been well-identified in received percutaneous coronary intervention (PCI) for chronic total occlusion (CTO), the advanced stages of atherosclerosis. We aim to determine whether the serum cystatin C-based-estimated glomerular filtration rate (eGFR) can have an improved predictive value in patients with CTO lesions undergoing PCI as compared with multiple creatinine-based estimates of kidney function. Six hundred and seventy-one patients received CTO PCI were retrospectively included in the study. The eGFR was calculated by modification of diet in renal disease equation for Chinese (cMDRD) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations at baseline, respectively. Then, the cohort was categorized into three groups according to standard KDIGO kidney stages based on eGFR. The primary endpoint was all-cause mortality, and the secondary endpoint was cardiac death. Strikingly, cystatin C-based eGFR showed a better performance with the greater area being under the receiver operating characteristic (ROC) curve (0.73 for all-cause mortality and 0.73 for cardiac death, separately) and a better assessment for survival free from adverse event across renal levels among four eGFR equations. Compared with eGFR calculated by other formulas, serum cystatin C-based eGFR showed the highest prognostic value for both all-cause mortality (adjusted HR 3.6, 95% CI 1.6–8.1, P = 0.002) and cardiac death (adjusted HR 2.9, 95% CI 1.0–8.1, P = 0.028). Moreover, cystatin C-based eGFR significantly improved the risk reclassification of event with a high value of net reclassification improvement and integrated discrimination improvement. This study may prove that cystatin C-based eGFR is a better predictor of both all-cause mortality and cardiac death than other equations in populations with CTO undergoing PCI.