Serum neutrophil gelatinase-associated lipocalin has an advantage over serum cystatin C and glomerular filtration rate in prediction of adverse cardiovascular outcome in patients with ST-segment elevation myocardial infarction.

BACKGROUND: The aim of this study was to assess significance of serum neutrophil gelatinase-associated lipocalin (sNGAL) and cystatin C (sCC) in prediction of adverse cardiovascular outcome after ST-segment elevation myocardial infarction (STEMI). METHODS: We recruited 357 consecutive patients who were admitted to the hospital within 24 h after onset of STEMI. On the 1st and 12th-14th day after hospital admission, we measured levels of sNGAL and sCC. We also determined presence of renal dysfunction (RD), defined as glomerular filtration rate < 60 mL/min/1.73 m2. After 3 years of follow-up, we performed a logistic regression and assessed the value of RD, sNGAL, and sCC in prediction of combined endpoint, defined as cardiovascular death or any cardiovascular complication. RESULTS: RD, sCC level ≥ 1.9 mg/L, and sNGAL level ≥ 1.25 ng/mL on the 12th-14th day of hospitalization were associated with a 1.6-fold, 1.9-fold, and 2.9-fold higher risk of adverse cardiovascular outcome, respectively. Area under the ROC curve was the highest for the model based on sNGAL level compared to the models based on sCC level or RD presence. CONCLUSIONS: Measurement of sNGAL level in patients with STEMI on the 12th-14th day after hospital admission may improve prediction of adverse cardiovascular outcome.

The role of cystatin C in the prognosis of adverse outcomes after the coronary artery bypass graft surgery during hospitalisation.

BACKGROUND: This study has been aimed to assess clinical significance of cystatin C in the prognosis of a risk of hospital complications among the patients with coronary artery disease CAD who have undergone coronary artery bypass surgery (CABG). METHODS: We have recruited 719 consecutive Caucasian (Russian) patients who underwent CABG in 2011-2012. RESULTS: No statistically significant differences in the serum creatinine concentration (sCr) and glomerular filtration rate before and seven days after the surgery have been found among the patients belonging to different EuroSCORE risk groups. A statistically significant elevation of serum cystatin C concentration (sCC) before and seven days after the surgery has been demonstrated in EuroSCORE medium- and high-risk groups in comparison with the low-risk group. In addition, we have revealed increased pre-surgical levels of sCC in patients who had died earlier than seven days after CABG. Regarding the cardiovascular complications, a statistically significant elevation of sCC has been observed in patients with and without myocardial infarction (MI), stroke, or acute kidney injury (AKI) in the postoperative period. CONCLUSIONS: We suggest that the determination of sCC before and after CABG surgery may help in the prognosis of adverse cardiovascular and renal outcomes after the CABG surgery.

Microalbuminuria and prediction of cardiovascular complications in patients with coronary artery disease and type 2 diabetes mellitus after CABG surgery.

BACKGROUND: This investigation was aimed at assessing the clinical significance of microalbuminuria (MA) in predicting in-hospital adverse outcomes amongst the patients with coronary artery disease (CAD) and type 2 diabetes mellitus (DM) who have undergone coronary artery bypass graft (CABG) surgery. METHODS: We recruited 720 consecutive Caucasian (Russian) patients who underwent CABG surgery during 2011-2012. RESULTS: Patients with renal dysfunction (RD) and without type 2 DM had significantly higher median serum creatinine seven days after CABG surgery compared to patients without RD and type 2 DM. There were no statistically significant intergroup differences regarding glomerular filtration rate. However, the highest median of urine albumin excretion 24hours before and seven days after CABG surgery was detected in patients with RD and type 2 DM whilst the lowest median was noted in patients without RD and type 2 DM. Median of urine albumin excretion 24hours before and seven days after CABG surgery in patients with adverse outcome was significantly higher compared to patients with a favourable outcome. CONCLUSIONS: We suggest that the determination of MA before and after CABG surgery may assist in predicting adverse outcomes after CABG surgery.