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Evolution of renal function and predictive value of serial renal assessments among patients with acute coronary syndrome: BIOMArCS study.

  • Brankovic, Milos1
  • Kardys, Isabella1
  • van den Berg, Victor2
  • Oemrawsingh, Rohit2
  • Asselbergs, Folkert W3
  • van der Harst, Pim4
  • Hoefer, Imo E5
  • Liem, Anho6
  • Maas, Arthur7
  • Ronner, Eelko8
  • Schotborgh, Carl9
  • The, S Hong Kie10
  • Hoorn, Ewout J11
  • Boersma, Eric12
  • Akkerhuis, K Martijn1
  • 1 Department of Cardiology, Erasmus MC, Rotterdam, the Netherlands. , (Netherlands)
  • 2 Department of Cardiology, Erasmus MC, Rotterdam, the Netherlands; Netherlands Heart Institute, Utrecht, the Netherlands. , (Netherlands)
  • 3 Laboratory of Clinical Chemistry and Hematology, UMC Utrecht, Utrecht, the Netherlands; Department of Cardiology, Division Heart & Lungs, University Medical Center Utrecht, University of Utrecht, the Netherlands; Durrer Center for Cardiovascular Research, Netherlands Heart Institute, Utrecht, the Netherlands. , (Netherlands)
  • 4 University Medical Center Groningen, Groningen, the Netherlands. , (Netherlands)
  • 5 Laboratory of Clinical Chemistry and Hematology, UMC Utrecht, Utrecht, the Netherlands. , (Netherlands)
  • 6 Sint Franciscus Gasthuis, Rotterdam, the Netherlands. , (Netherlands)
  • 7 Gelre Hospital, Zutphen, the Netherlands. , (Netherlands)
  • 8 Reinier de Graaf Hospital, Delft, the Netherlands. , (Netherlands)
  • 9 HagaZiekenhuis, Den Haag, the Netherlands. , (Netherlands)
  • 10 Treant Zorggroep, location Bethesda, Hoogeveen, the Netherlands. , (Netherlands)
  • 11 Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus MC, Rotterdam, the Netherlands. , (Netherlands)
  • 12 Department of Cardiology, Erasmus MC, Rotterdam, the Netherlands. Electronic address: [email protected] , (Netherlands)
Published Article
International journal of cardiology
Publication Date
Jan 15, 2020
DOI: 10.1016/j.ijcard.2019.07.052
PMID: 31353156


Impaired renal function predicts mortality in acute coronary syndrome (ACS), but its evolution immediately following index ACS and preceding next ACS has not been described in detail. We aimed to describe this evolution using serial measurements of creatinine, glomerular filtration rate [eGFRCr] and cystatin C [CysC]. From 844 ACS patients included in the BIOMArCS study, we analysed patient-specific longitudinal marker trajectories from the case-cohort of 187 patients to determine the risk of the endpoint (cardiovascular death or hospitalization for recurrent non-fatal ACS) during 1-year follow-up. Study included only patients with eGFRCr ≥ 30 ml/min/1.73 m2. Survival analyses were adjusted for GRACE risk score and based on data >30 days after the index ACS (mean of 8 sample per patient). Mean age was 63 years, 79% were men, 43% had STEMI, and 67% were in eGFR stages 2-3. During hospitalization for index ACS (median [IQR] duration: 5 (3-7) days), CysC levels indicated deterioration of renal function earlier than creatinine did (CysC peaked on day 3, versus day 6 for creatinine), and both stabilized after two weeks. Higher CysC levels, but not creatinine, predicted the endpoint independently of the GRACE score within the first year after index ACS (adjusted HR [95% CI] per 1SD increase: 1.68 [1.03-2.74]). Immediately following index ACS, plasma CysC levels deteriorate earlier than creatinine-based indices do, but neither marker stabilizes during hospitalization but on average two weeks after ACS. Serially measured CysC levels predict mortality or recurrence of ACS during 1-year follow-up independently of patients' GRACE risk score. Copyright © 2019 Elsevier B.V. All rights reserved.

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