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Cystatin C as a predictive marker of renal dysfunction and mid-term outcomes following off-pump coronary artery bypass grafting

 Seung Hyun Lee  ;  Young-Nam Youn  ;  Hyun Chel Choo  ;  Sak Lee  ;  Kyung-Jong Yoo 
 HEART, Vol.101(19) : 1562-1568, 2015 
Journal Title
Issue Date
Adrenal Cortex Hormones/therapeutic use ; Adult ; Aged ; Azathioprine/therapeutic use ; Colectomy/statistics & numerical data ; Colitis, Ulcerative/drug therapy* ; Cyclosporine/therapeutic use* ; Drug Therapy, Combination ; Female ; Humans ; Immunosuppressive Agents/therapeutic use* ; Infliximab/therapeutic use* ; Male ; Middle Aged ; Proportional Hazards Models ; Republic of Korea ; Retrospective Studies Aged ; Area Under Curve ; Biomarkers/blood ; Chi-Square Distribution ; Coronary Artery Bypass, Off-Pump/adverse effects* ; Coronary Artery Bypass, Off-Pump/mortality ; Creatinine/blood ; Cystatin C/blood* ; Female ; Humans ; Kaplan-Meier Estimate ; Kidney/physiopathology ; Kidney Diseases/blood ; Kidney Diseases/diagnosis ; Kidney Diseases/etiology* ; Kidney Diseases/mortality ; Kidney Diseases/physiopathology ; Male ; Middle Aged ; Multivariate Analysis ; Predictive Value of Tests ; ROC Curve ; Retrospective Studies ; Risk Factors ; Time Factors ; Treatment Outcome ; Treatment Outcome ; Young Adult
OBJECTIVE: To determine whether plasma cystatin C and creatinine levels after isolated off-pump coronary artery bypass grafting (OPCAB) are predictive of postoperative renal dysfunction and clinical outcomes. METHODS: Between January 2008 and December 2013, 1033 who underwent isolated OPCAB were recruited. The patients were divided into three groups according to the preoperative level of cystatin C: low (0.83 mg/L>), mid (0.83-1.13 mg/L) and high (1.13 mg/L<). The endpoints of all-cause mortality and major adverse cerebrovascular and cardiovascular events were compared among three groups using the Kaplan-Meier method. The predictive power of cystatin C was compared with creatinine using receiver operating curves. RESULTS: Follow-up was complete in all of the included patients at a mean of 2.9±1.5 years. Within the follow-up period, 9 early (30-day mortality) and 46 late deaths occurred. The 30-day mortality was zero, four (44%), and five (56%) cases in low, mid and high groups, respectively (p=0.03). The cut-off value of cystatin C for renal dysfunction prediction was approximately 1.04 (mg/L, p<0.001), and cystatin C showed greater predictive power than creatinine for renal dysfunction (area under the curve=0.73 vs 0.65; p=0.01). One-year and five-year overall survival in low, mid and high groups were 99.2%, 98.9% and 94.3%, and 97.9%, 97.3% and 86.3%, respectively (low vs high, p=0.01). CONCLUSIONS: Cystatin C is a stronger predictor of postoperative renal dysfunction than serum creatinine, and its level is directly correlated with mid-term OPCAB adverse results.
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1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
Yonsei Authors
Yoo, Kyung Jong(유경종) ORCID logo https://orcid.org/0000-0002-9858-140X
Youn, Young Nam(윤영남)
Lee, Sak(이삭) ORCID logo https://orcid.org/0000-0001-6130-2342
Lee, Seung Hyun(이승현) ORCID logo https://orcid.org/0000-0002-0311-6565
Joo, Hyun Chel(주현철) ORCID logo https://orcid.org/0000-0002-6842-2942
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