Abstract

Circulating cystatin C level has been identified as a predictor of adverse outcomes in patients with coronary artery disease (CAD). This meta-analysis aimed to investigate the value of circulating cystatin C level for predicting adverse outcomes in patients with acute coronary syndrome (ACS). We comprehensively searched articles indexed in Pubmed and Embase databases from their inceptions to 30 November 2019. All available observational studies that investigated the association between circulating cystatin C level and major adverse cardiovascular events [MACE] (including death, heart failure, re-infarction, target vascular revascularization, angina and stroke) or all-cause mortality in patients with ACS were included. The prognostic value was expressed by pooling the multivariable-adjusted hazard risk (HR) with 95% confidence interval (CI) for the highest versus the lowest category of cystatin C level. Eleven eligible studies (12 articles) with 4600 ACS patients were identified. Meta-analysis indicated that the highest versus lowest category of cystatin C level was associated with higher risk of MACE (HR 2.28; 95% CI 1.92–2.71) and all-cause mortality (HR 2.89; 95% CI 1.43–5.83) after adjustment for estimated glomerular filtration rate (eGFR) or creatinine. Subgroup analysis by subtypes of patients, study design, follow-up duration and cutoff level of cystatin C further confirmed the value of cystatin C level for predicting MACE. Elevated circulating cystatin C level at baseline is strongly and independently associated with an increased risk of MACE and all-cause mortality in patients with ACS. Determination of circulating cystatin C level has potential to improve risk stratification of ACS patients.

摘要

循环胱抑素 C 水平已被确定为冠状动脉疾病 (CAD) 患者不良结局的预测指标。本荟萃分析旨在研究循环胱抑素 C 水平对预测急性冠状动脉综合征 (ACS) 患者不良结局的价值。我们全面搜索了从 Pubmed 和 Embase 数据库开始到 2019 年 11 月 30 日索引的文章。所有现有的观察性研究调查了循环胱抑素 C 水平与主要不良心血管事件 [MACE]（包括死亡、心力衰竭、再梗死、包括目标血管血运重建、心绞痛和中风）或 ACS 患者的全因死亡率。预后值通过将多变量调整的危险风险 (HR) 与 95% 置信区间 (CI) 合并为最高类别与最低类别的胱抑素 C 水平来表示。确定了 11 项符合条件的研究（12 篇文章），涉及 4600 名 ACS 患者。Meta 分析表明，最高与最低类别的胱抑素 C 水平相比，在调整估计肾小球滤过率 (eGFR) 后，MACE 风险较高（HR 2.28；95% CI 1.92–2.71）和全因死亡率（HR 2.89；95% CI 1.43–5.83） ) 或肌酐。按患者亚型、研究设计、随访时间和胱抑素 C 截止水平进行的亚组分析进一步证实了胱抑素 C 水平预测 MACE 的价值。基线时循环胱抑素 C 水平升高与 ACS 患者的 MACE 风险和全因死亡率增加密切相关，且独立相关。测定循环胱抑素 C 水平有可能改善 ACS 患者的风险分层。