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Cystatin C in Acute Coronary Syndromes: The Investigation Should Go On pp. 121-142 $100.00
Authors:  (S. Ferraro, G. Marano, B. Suardi, P. La Musta, E.M. Biganzoli, A.S. Bongo, P. Boracchi, SCDO, Cardiologia 2, Ospedale Maggiore, Novara, Italy, and others)
Background: Cystatin C(CC) could contribute adding value to traditional cardiovascular risk factors in the prediction of adverse events in Acute Coronary Syndromes (ACS). Aim of present chapter is to assess the evidence on the prognostic value of CC in ACS patients, by reviewing current literature. Methods and Results: by Pub Med, Embase, Ovid, 29 papers were identified, and 9 longitudinal observational studies in which serum CC was investigated as prognostic
marker in ACS, were selected. The reference populations allowed to classify studies in: Group A) 4 studies with 50-60% of ACS patients and a sample size of 450-1030 patients; Group B) 3 studies on non ST Elevation Acute Coronary Syndromes (NSTEACS) patients and a sample size of 380-1120 patients; Group C) 1 study with 160 ST Elevation
Myocardial infarction (STEMI) and NSTEACS patients; Group D) 1 study with 71 STEMI. Outcome: The end-point was “time to”: 1) cardiovascular death, non fatal myocardial infarction (MI), or stroke, with a median follow up of 3 years; 2) major adverse cardiovascular events (MACE), with a variable median follow up of 3 years, 1 year, and 6 months; 3) death or recurrence of MI, with a median follow up of 3 years, 6 months. Prognostic role: According to results in: - Group A CC levels >1.3 mg/L were a significant risk factor for fatal and non fatal cardiovascular events (HR estimates ranging from 1.72 to 2.27); -Group B, for CC levels >1.25 mg/L, the risk of death was about 12 times greater than that of patients with lower CC levels; in a second study, for CC levels >1.01 mg/L a significant prognostic value on death was found (HR=4.07 (CI:2.16-7.66)). According to the recurrence of AMI evaluated in two studies, only one assessed a significant prognostic role (HR=1.95(CI:1.05-3.63)). For another study , according to a composite endpoint of fatal and non fatal cardiac events, with a CC >0.93 mg/L, a HR of 1.57( CI:1.04-2.49) was shown. For Groups C and D similar results on the prognostic value of CC on MACE were obtained: HR=9.43(CI:4.0-21.8) for CC levels >1.05 mg/L, HR =2.17(CI:1.07-6.98) for CC levels >0.96 mg/L. 

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Cystatin C in Acute Coronary Syndromes: The Investigation Should Go On pp. 121-142