Biochemical Significance of Cystatin-C and High-Sensitive CRP in Patients with Acute Coronary Syndrome; any Clinical Correlation with Diagnosis and Ejection Fraction

Abstract

Asseel K. Shaker, Raghdan Al-Saad, Raad Jasim, Hayder Abdul-Amir Makki Al-Hindy

Introduction: Acute coronary syndrome (ACS) is a life-threatening disorder that remains a source of high morbidity and mortality despite advances in treatment. Risk assessment of ACS done by using risk factors and risk markers, CRP is not merely an inflammatory marker but may also participate in the pathogenesis of atherosclerosis and myocardial injury. Additionally, Cystatin-C (Cy/C) is a biomarker recognized for monitoring renal impairment, recently, showed an associated significance with the incidence of coronary vascular atherosclerosis and systolic ventricular dysfunction.
Aim of the study: This study designed to inspect the clinical impact of Cy/C and Hs/CRP circulating levels in patients with ACS and to evaluate their association with diagnosis, ejection fraction (EF) and the angiographic number of stenosed coronaries.
Materials and methods: This is a single-center cross-sectional study involved 136 ACS patients and 94 controls. Comparisons of measures of body mass index and serum measurements of Cy/C, Hs/CRP, uric acid (UA), creatinine, and estimated glomerular-filtration-rate (eGFR) between the two groups. Further echocardiographic examinations and angiographic imaging were performed by interventionalists for ACS patients. According to their levels; Cy/C was classified into quartiles and Hs/CRP into tertiles.
Results: Mean patients' age was 57.3±13 years. The mean plasma UA values were significantly higher in patients. The eGFR was significantly lower in ACS people. Mean sera levels of both Hs/CRP and Cy/C were significantly higher in cardiac patients. There was a higher incidence of associated risk factors in terms of tobacco use, hypertension and diabetes mellitus. Around two-thirds of the patients had lower Cy/C quartiles, despite no variation in the distribution of all study variables according to Hs/CRP tertiles. Univariable regression analysis shows no significant correlation among uric acid, eGFR, LVEF, and Hs/CRP with Cy/C levels in ACS patients. ROC analysis for both Cy/C and Hs/CRP biomarkers compared to UA showed higher sensitivity and specificity significantly.
Conclusion: Both Cy/C and Hs/CRP were significantly higher in ACS patients than controls. No significant correlation was observed among uric acid, eGFR, and Hs/CRP with Cy/C levels in ACS patients.