血清胱抑素C水平对老年冠状动脉介入术后患者造影剂诱导急性肾损伤发生及其远期预后的影响

目的:探讨胱抑素C(CysC)水平对老年冠状动脉介入治疗(PCI)患者术后造影剂诱导的急性肾损伤(CI-AKI)发生及其远期预后的影响。方法:前瞻性连续入选2015年3月至2017年12月间在我院心内科接受PCI治疗的老年患者848例，CI-AKI定义为应用碘造影剂48～72 h内血清肌酐升高≥44.2 μmol/L，...

Effects of serum cystatin C level on the occurrence and its long-term prognosis of contrast agent-induced acute kidney injury after coronary intervention in elderly patients

Objective To investigate the effect of serum cystatin C level on the occurrence and its long-term prognosis of contrast agent-induced acute kidney injury(CI-AKI)after percutaneous coronary intervention(PCI)in elderly patients.Methods A total of 848 elderly patients(≥60 years)undergoing PCI in our department between Mar 2015 and Dec 2017 were enrolled in a prospective cohort.The CI-AKI was defined as the increase of serum creatinine≥44.2μmol/L within 48-72 h after using iodine contrast agent or more than 25%higher than base level within 48-72 h after PCI.A receiver operating characteristic curve was used to analyze the optimal cut-off value of Cystatin C for predicting CI-AKI after PCI.Patients were divided into 2 groups based on the optimal cut-off value of Cystatin C:the high Cystatin C group(Cystatin C≥1.3 mg/L,n=178)and the control group(Cystatin C<1.3 mg/L,n=670).The differences in the incidence of CI-AKI after PCI and major adverse cardiac events(MACE)at 1 year follow-up were compared between the two groups.The Cox regression model was further used to analyze the predictors of the long-term prognosis after PCI.Results Of 848 patients receiving PCI,the incidence of CI-AKI was 9.4%.The incidence of MACE at 1 year after PCI was higher in the high Cystatin C group than in the control group(15.7%vs.9.3%,χ2=6.524,P=0.011).Cox regression analysis confirmed that the high baseline level of Cystatin C was the most independent predictive factor for MACE at 1 year of follow-up(HR=16.244,P<0.001).Conclusions The high baseline level of Cystatin C(≥1.3 mg/L)is an independent risk factor for CI-AKI and is also the most important predictor for the occurrence of long-term MACE in elderly patients undergoing PCI.