Association Of Cystatin C And Coronary Artery Severity In Patients With Acute Coronary Syndrome And Diabetes Mellitus And Its Correlation With Short-term Prognosis

Objective: Acute Coronary Syndrome(ACS) is the most common emergency and severe cardiovascular system disease, which usually exist the unstable and severe coronary artery lesion. The morbidity of ACS have an increasing tendency year by year, which have a serious threat to the health and lives of patients. To cure it in time and effectively, and to realize the degree of its risk and nip in the bud will save patients’ life effectively. Diabetes mellitus is an important risk factor of coronary atherosclerosis. In patients with diabetes mellitus there is an increased coronary artery lesion and mortality. At present, they have aroused widespread attention at home and abroad. Currently a large number of clinical study at home and abroad have been made to explore the association of Cystatin C(Cys C) and coronary artery severity in patients with ACS and its correlation with short-term prognosis. Multiple study demonstrate that Cys C has a positive correlation with coronary artery severity and that Cys C is an independent association with short-term prognosis. However, the association between Cys C and coronary artery severity in patients with ACS and Diabetes mellitus has seldom been reported. It has been unknown that what are the risk factors of short-term prognosis in patients with ACS and diabetes mellitus, so it is necessary to deeply explore it.In general, this study has been designed to analyze the association between Cys C and coronary artery severity and to analyze the risk factors of short-term prognosis in patients with ACS and diabetes mellitus. This will provide basis for clinical treatment through predicting the degree of risk in patients with ACS and diabetes mellitus.Methods: We selected 391 cases of patients diagnosed with ACS enrolled in the Department of Cardiology, the Second Hospital of Hebei Medical University from December 2013 to July 2014. ACS diagnosis is based on the 2012 non-ST segment elevation acute coronary syndrome(NSTE-ACS) guidelines and 2010 ST segment elevation myocardial infraction(STE-AMI) guidelines of Chinese Medical Association. Inclusion criteria: 1) Conform to the diagnostic criteria of ACS. 2) Age in 18 years old to 90 years old. 3) Coronary angiography show that at least one vascular stenosis is more than 50%. 4) Admission within one week.Exclusion criteria: Patients with severe hepatic and renal dysfunction, thyroid disease, congenital heart disease, rheumatic heart disease, valvular heart disease, myocardiopathy, pulmonary heart disease, malignant tumor, connective tissue disease, type 1 diabetes, pregnant and lactant patients, infectious and inflammatory disease were excluded from the study. We collected their clinical data after admission, including age, gender, medical history(high blood pressure, diabetes, smoking, drinking history, et al.), medications, systolic blood pressure(SBP), diastolic blood pressure(DBP), heart rate(HR), body mass index(BMI) and so on. After admission, fasting serum cystatin C(Cys C), fasting blood-glucose(FBG), glutamate pyruvate transaminase(ALT), total cholesterol(TC), triglycerides(TG), low density lipoprotein-c(LDL-c), high density lipoprotein-c(HDL-c), serum creatinine(SCr) and fibrinogen(Fg) et al. were all tested. All patients underwent coronary angiography. The patients with diabetes mellitus were also treated with insulin or oral agents.According to the results of coronary angiography, the severity of coronary artery disease was defined using the Gensini score and coronary artery lesion blood vessel counts. According to coronary artery lesion blood vessel counts, it divided into three groups, including single vessel lesion, double vessel lesion and multiple vessel lesion. All patients were followed up for six months, to record short-term prognosis shown as major adverse cardiovascular events(MACE), including cardiogenic death, nonfatal myocardial infarction, and target vessel revascularization.According to the diabetes mellitus, the patients with diabetes mellitus served as A group, and others served as B group. Whether is statistical difference from comparing general data and Cys C, Gensini score, the rate of multiple vessel diseases and MACE of two groups or not.Analyze the correlation of Gensini score with Cys C in patients with ACS respectively.It divided into three groups depending on coronary artery lesion blood vessel counts, including single vessel group, double vessel group and multiple vessel group. Analyze Cys C level of their three groups. Analyze the correlation of coronary artery lesion blood vessel counts with Cys C in patients with ACS respectively.Factors impacting MACE in patients with ACS were analyzed respectively.Statistical methods: All the statistical tests were performed in SPSS version 19.0. A two-tailed P value of less than 0.05 was considered statistically significant. Continuous variables were expressed as the arithmetic mean and standard deviation or as the median and interquartile range, depending on whether or not they showed a gaussian distribution. The student’s t test or the Wilcoxon ranksum test was carried out for comparison of two groups, depending on whether or not they showed a gaussian distribution. the measurement data among many groups were compared using analysis of variance. Discrete variables were expressed as percentage and compared with the chi-square test. Ordinal logistic regression and Pearson and partial correlation were used to analyze the association between Cys C and Gensini score. Correlation between the coronary artery lesion blood vessel counts with Cys C was explored using Spearman correlation analysis. Factors considered to affect MACE were evaluated by the multivariate logistic regression model.Results:1 ACS with diabetes mellitus(A group) and without diabetes mellitus(B group)We selected 391 cases of patients diagnosed with ACS. There were 231 cases of patients with diabetes mellitus. Compared with the B group, age, gender, BMI, history of hypertension, smoking history, drinking history, SBP, DBP, HR and ALT, SCr, TG, TC, HDL-c, LDL-c, Fg in A group had no significant difference. The level of FBG in A group is higher than B group(8.76±1.19 vs 5.21±0.87). It was significantly different(P<0.05). The level of Cys C in A group is higher than B group(0.94±0.24 vs 0.83±0.15). It was significantly different(P<0.05). The level of Gensini score in A group is higher than B group(52.20±6.34 vs 34.52±5.22). It was significantly different(P<0.05). The rate of multiple lesions in A group is higher than B group(41.13% vs 21.88%). It was significantly different(P<0.05). The incidence of MACE in A group is higher than B group(14.71% vs 8.33%). It was significantly different(P<0.05).2 A group: Gensini score had significantly correlation with Cys C(r=0.361, P<0.05). Adjusted with confounding factors including SBP, DBP, TC, TG, LDL-c, HDL-c, SCr, the Gensini score also had significantly correlation with Cys C(rp=0.328, P<0.05). Ordinal logistic regression showed that Cys C was an independent predictor of Gensini score(β=1.217, P<0.05).B group: Gensini score had significantly correlation with Cys C(r=0.208, P<0.05). Adjusted with confounding factors including SBP, DBP, TC, TG, LDL-c, HDL-c, SCr, Gensini score had no significantly correlation with Cys C(P>0.05).3 It divided into three groups depending on coronary artery lesion blood vessel counts, including single vessel group, double vessel group and multiple vessel group. The Cys C level of three groups of A group(0.74±0.11 vs 0.88±0.15 vs 0.95±0.22) is significant difference(P<0.05). Cys C rises with the increase of coronary lesion vessel counts. Coronary lesion vessel counts had significant correlation with Cys C(rs=0.534, P<0.05).The Cys C level of three groups of B group(0.71±0.09 vs 0.78±0.12 vs 0.85±0.13) is no significant difference(P>0.05). Coronary lesion vessel counts had no significant correlation with Cys C(P>0.05).4 The ordinal logistic regression was employed to control for multiple covariates when analyzing the factors of MACE in patients with ACS. MACE served as dependent variable. The model of regression enrolled in age, gender, SBP, DBP, BMI, HR, FBG, TC, TG, LDL-c, HDL-c, Fg, Cys C and Gensini score. On multivariate analysis, Cys C and Gensini score could be both independent risk factors of the occurrence of MACE in A group(Their OR values were 2.97, 1.65, P all <0.05). Gensini score could be an independent risk factor of the occurrence of MACE in B group(Its OR value was 1.47, P <0.05).Conclusions:1 Comparison in patients with ACS and diabetes mellitus and ACS without diabetes mellitus, there are higher levels of Cys C, more severely coronary stenosis degree and worse short-term prognosis.2 Cys C had positively correlation with coronary artery severity in patients with ACS and diabetes mellitus, which is an independent predictive factor of coronary artery severity in patients with ACS and diabetes mellitus.3 Cys C is an independent risk factor for short-term prognosis in patients with ACS and diabetes mellitus.