Combination CAC score, cystatin C more accurately predicts CV events, death
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In symptomatic patients, coronary artery calcium score combined with cystatin C level can provide more accurate risk stratification for major adverse CV events and all-cause death than either measure alone, researchers reported.
“In people with the symptom of chest pain suggestive of CHD, it is uncertain whether the CAC score and cystatin C can identify people at different risks of cardiovascular events or death, and whether their combination can provide complementary prognostic information for further risk stratification to identify people with higher or lower risks,” Yi‐Ning Yang, MD, PhD, of the People’s Hospital of Xinjiang, China, and colleagues wrote in Clinical Cardiology. “To address this issue, we evaluated the association of baseline CAC score and cystatin C with future major adverse cardiac and cerebrovascular events (MACCE) and all‐cause death in symptomatic patients.”
Yang and colleagues analyzed data from 7,140 patients reporting chest pain at the First Affiliated Hospital of Xinjiang Medical University in China who underwent cardiac CT to measure CAC score between December 2013 and April 2020. Researchers assessed cystatin C from blood samples. The primary composite outcome was MACCE, defined as time to first instance of coronary revascularization, MI, fatal and nonfatal stroke, malignant arrhythmias, HF or CV death. The secondary endpoint was all-cause death.
During a median of 1,106 days of follow-up, 305 patients experienced MACCE and 191 patients died.
Researchers found that a CAC score of 100 or greater and a cystatin C level of 0.995 mg/L or greater were independently associated with an increased risk for MACCEs, with an adjusted HR of 1.46 for CAC score (95% CI, 1.15-1.85; P = .002) and an adjusted HR of 1.57 for cystatin C (95% CI, 1.24-2; P < .001).
Compared with patients with a CAC score below 100 and a cystatin C level below 0.995 mg/L, those with a CAC score above 100 and a cystatin C level above 0.995 mg/L had the highest risk for MACCE and all‐cause death, with adjusted HRs of 2.33 (95% CI, 1.64-3.29; P < .001) and 2.85 (95% CI, 1.79-4.55; P < .001), respectively.
A cystatin C level above 0.995 mg/L was also associated with higher risk for MACCE and all-cause death among patients with a CAC score below 100, according to the researchers, with adjusted HRs of 1.76 (P = .003) and 2.02 (P = .007), respectively.
“The combined stratification of the two indicators showed an incremental risk of MACCEs and all‐cause death, reflecting complementary prognostic value, and was used to separate populations at different risks of MACCEs and all‐cause death,” the researchers wrote. “Our study extends risk stratification using CACS or cystatin C alone to a combination of the two and may suggest a new cardio‐renal axis risk stratification approach. The value of this approach for treatment decision‐making needs to be confirmed in future studies.”
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