Explore The Clinical Significance Of Serum Cystatin C In Patients With Pump Failure Afrer Acute Myocardial Infarction

Objective:By comparing the differences of serum cystatin C in patients with acute myocardial infarction,analyze the relations between serum cystatin C and pump failure.By discussing the correlation of serum cystatin C and brain natriuretic peptide(BNP),cardiac function parameters from cardiac ultrasound,explore the clinical significance of the diagnosis of serum cystatin C in acute myocardial infarction patients with pump failure.Method:This research is a retrospective study.Patients with acute myocardial infarction undergoing primary percutaneous coronary intervention(PCI)were consecutively and prospectively enrolled in this study.234 patients from the emergency department of the first affiliated hospital of China medical university from January 2015 to January 2018 were enrolled in this study.According to the Killip classification,Eligible patients were randomly divided into Killip I(A)and Killip II-IV(B)cohorts.The patients enrolled in the emergency department had a blood examination,including routine,renal function,serum ion(potassium sodium chloride),uric acid and other biochemical indicators on the day of admission.on the next morning,the liver function,blood lipid series,BNP,serum cystatin C and other biochemical indexes were examined.During the hospitalization,echocardiographic wall motion score index was analyzed on admission.Analying the differences and relation of variables collected is carried out to explore the clinical significance of the diagnosis of serum cystatin C in patients with pump failure after acute myocardial infarction.Sensitivity and specificity of the risk score was assessed by the area under the receiver operating characteristic curve(AUROC).Cutoff value for diagnosing pump failure was determined by maximum Youden index.Expore the clinical significance of the diagnosis of serum cystain C in parents with pump failure after acute myocardial infarction.Result: There were 234 patients acute myocardial infarction undergoing primary percutaneous coronary intervention(PCI)were recruited.154 patients were in A cohort and 79 patients were in B cohort.A comparative analysis of ages,serum cystatin C,BNP and LDL-C showed a good discrimination.Furthermore,the correlation between serum cystatin C and various variables was analyzed.Serum cystatin C was positively correlated with BNP(r=0.487,P<0.01);Serum cystatin C was negatively correlated with ejection fraction(r=-0.342,P<0.01)and Stroke volume(r=-0.245,P<0.01);Serum cystatin C was positively correlated with left ventricular systolic volume(r=0.25,P<0.01);There was no correlation between serum cystatin C and left ventricular diastolic volume.Sensitivity and specificity of the risk score was assessed by the area under the receiver operating characteristic curve(AUROC).Cutoff value for diagnosing pump failure was determined by maximum Youden index.Serum cystatin C has an AUROC of 0.613.BNP has an AUROC of 0.589,A combination of serum cystain C and BNP has an AUROC of 0.612.When the cutoff value of serum cystatin C is 0.925mg/L,it has a maximum Youden's index,and its sensitivity is 55.7%,specificity is 73.4%.When the cutoff value of BNP is 326.5pg/ml,it has a maximum Youden's index,and its sensitivity is 27.8%,specificity is 92.9%.In addition,a combination of Serum cystatin C and BNP has a better sensitivity and specificity than BNP.Conclution:1.Serum cystatin C is closely related to the degree of pump failure in the paitents after acute myocardial infarction.2.The combination of serum cystatin C and BNP have a more remarkable significant in the diagnosis of early pump failure.