Prognostic Value Of Circulating Catcstatin Levels On Hospitalized Patients With Acute Myocardial Infarction

ObjectiveTo evaluate prognostic value of circulating catestatin (CST) on hospitalized patients withacute myocardial infarction (AMI).MethodsThe data of 125 patients (median age 62 years, 71% male) with AMI were collected fromthe Second Hospital of Shanxi Medical University and Taiyuan central hospitalduring the periodof Novenber 2010 to July 2011.Recording age, gender,body mass index (BMI), smoking history,past medical history, blood pressure, heart rate, Killip class at the time of admission, variousbiochemical index, cardiac ultrasonography (the first 72 hours after admission) ect. andtherapeutic approaches, the incidence of malignant events. The malignant events of this researchincluded malignant arrhythmia, heart failure, angina or reinfarction, death. Malignant arrhythmiawas defined as the emergence of new atrial fibrillation or atrial flutter, ventricular tachycardia,ventricular fibrillation, highly atrioventricular block accompany with hemodynamic instability,excepted arrhythmias accompany with ST segment dropped when accepting reperfusion therapy.Killip class≥2 was deemed to heart failure. The patients were categorized into 4 groupsaccording to CST (pg/ml) quartile:≤73.60、73.61-78.47、78.48-83.18 and≥83.19 pg/ml. Clinicalfeatures; therapeutic approaches; and the incidence of heart failure, malignant arrhythmias，angina or reinfarction and death during hospitalization were compared among groups. At thesame time the patients were grouped into whether AMI with heart failure, if AMI with heartfailure, were divided into three subunits according to Killip class. And the patients were alsogrouped into whether AMI with malignant arrhythmias. CST, norepinephrine (NE) ,amino-terminal pro-brain sodium peptides (NT-proBNP) were compared among groups.Multivariate logistic regression analysis was applied to determine the association between riskfactors and in-hospital malignant events, heart failure,malignant arrhythmia occurred.Receiver-operator characteristic(ROC) curve was performed to evaluate the power of CST onpredicting in-hospital malignant events, heart failure, malignant arrhythmias occurred. Results(1) Clinical features: Gender, hospital days, past history of smoking, past history ofhypertension, past history of myocardial infarction, CK-MB peak level, TnI peak level, heart rate,blood pressure, blood glucose, blood fat levels on admission and early reperfusion therapy weresimilar among groups. Patients with higher CST values were more likely to be older, to havelower BMI and left ventricle ejection fraction (LVEF); to have higher white blood cell count,Cystatin-C (CysC), high sensitivity C-reactive protein (hs-CRP), NE, NT-proBNP value ;to morelikely have past history of angina, past history of diabetes mellitus; to more diuretic users.(2) In-hospital malignant events: Higher CST levels were associated with increased risk ofheart failure, malignant arrhythmias and death(p<0.05). The area under the ROC curve of CSTwas 0.729, 95%CI: 0.640-0.817, when CST=72.65 (pg/ml), had the best sensitivity (92.7%) andspecificity (72.9%). After multivariate adjustment age, CST, NT-proBNP remained to beindependent risk factors for increased in-hospital malignant events occurred.(3) AMI with heart failure: CST and NT-proBNP levels were higher in AMI with heartfailure(P<0.01), but NE were similar between two groups(P>0.05). CST, NE, NT-proBNPlevels were increased in proportion to increasing Killip grades (II-IV). The area under the ROCcurve of CST was 0.714, 95%CI: 0.638-0.791, when CST=70.08（pg/ml）, had the best sensitivity(95.6%) and specificity (70.6%) . After multivariate adjustment age, history of heart failure,hs-CRP, CST, NT-proBNP remained to be independent risk factors for increased in-hospital heartfailure occurred.(4) AMI with malignant arrhythmias: CST, NE, NT-proBNP levels were higher in AMI withmalignant arrhythmias (P<0.05). The area under the ROC curve of CST was 0.725,95%CI:0.629-0.820, when CST=70.35(pg/ml), had the best sensitivity (96.9%) and specificity(78.7%). After multivariate adjustment pathoglycemia (≥6.1mmol/l), CST remained to beindependent risk factors for increased in-hospital malignant arrhythmias occurred.Conclusions(1) The plasma CST level is an independent predictor to in-hospital malignant events occurredand to some extent CST provides incremental prognostic information to conventionalcardiovascular risk marker for patients with AMI.(2) The plasma CST level is an independent risk factor for heart failure occurred duringhospitalization in patients with AMI and can give an index to cardiac function.(3) The plasma CST level is significant associated with in-hospital malignant arrhythmiasoccurred, and have a certain accuracy to prognose malignant arrhythmias occurred for patientswith AMI.