A biomarker for estimating no-reflow phenomenon in PCI-treated non-ST-segment elevation myocardial infarction patients: serum Cystatin C

Abstract

Aims: Cystatin C (Cys-C) is a biochemical marker associated not only with renal function but also with inflammatory processes. We aimed to investigate the relationship between the post-percutaneous coronary intervention (PCI) no-reflow phenomenon (NRP) and Cys-C in patients with non-ST-segment elevation acute coronary syndrome (NST-ACS). Methods: This retrospective, single-center observational study consecutively enrolled patients who were hospitalized with a diagnosis of NST-ACS and underwent PCI between October 2021 and February 2022. Baseline characteristics, medications, admission laboratory parameters, and angiographic features were recorded. Logistic regression and sensitivity analyses were performed to identify parameters associated with NRP. Results: Out of 199 patients (mean age: 62.0±10.3, 59.8% male), 36 (18.1%) developed NRP. Patients who developed NRP had a lower ejection fraction (49.7±10.3% vs. 53.5±7.1%, p=0.046) and were less likely to be male (36.1% vs. 65.0%, p=0.001). Additionally, individuals with NRP exhibited higher blood urea and C-reactive protein levels than those without NRP (p<0.05 for both). Similarly, serum Cys-C levels were elevated in the former group (1.44±0.57 vs. 1.07±0.40 mg/L, p=0.001). Multivariable logistic regression analysis demonstrated that Cys-C [odds ratio (OR)=4.793, p=0.014] and culprit lesion [OR=8.112, p=0.043 for LCx, OR=27.025, p=0.001 for RCA] were independently associated with NRP. Receiver operating characteristic curve analysis showed a cut-off point >1.1 mg/L for Cys-C determined NRP with 72.2% sensitivity and 66.9% specificity (area under the curve=0.711, p<0.001). Conclusion: We have demonstrated a potential association between the serum Cys-C level at admission and the occurrence of NRP among NST-ACS patients undergoing PCI.

Keywords

• Cystatin C
• no-reflow phenomenon
• non-ST-segment elevation acute coronary syndrome
• percutaneous coronary intervention

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