IJCS | Volume 31, Nº3, May/ June 2018

301 Martucheli et al. Cystatin C and acute coronary syndromes International Journal of Cardiovascular Sciences. 2018;31(3)290-307 Review Article Ichimoto et al., 2009 7 Cystatin C ≥ 0.96 mg/L Cystatin C < 0.96 mg/L Killip class ≥ 2; time elapsed from hospital admission to angioplasty; cystatin C ≥ 0,96 mg/L; previous MI; increased creatinine; age. Risk of cardiovascular events or all-cause mortality: Multivariate analysis: Cystatin C ≥ 0.96 mg/L: OR = 2.17 (1.07-6.98). p = 0.04 Kilic et al., 2009 27 Patients with cystatin C > 1,051 ng/mL who developed fatal or non-fatal cardiovascular events Patients with cystatin C > 1,051 ng/mL who did not develop fatal or non-fatal cardiovascular events Female sex; previous hypertension; previous DM; smoking; previous use of ACE inhibitor; previous use of diuretics; EF; creatinine clearance; fasting glycemia; log cystatin C; log BNP Proportion of patients cystatin C > 1051 ng/ mL who developed or not fatal and non-fatal cardiovascular events: 67% x 30% (developed cardiovascular events X did not develop cardiovascular events). p < 0.001 Risk of fatal and non-fatal cardiovascular events Univariate analysis: Log (Cystatin C): RR = 9.25 (3.94-21.6). p = < 0.001 Multivariate analysis: Log (Cystatin C): RR = 9.43 (4-21.8). p = < 0.001 García Acuña et al., 2009 28 Cystatin C > 0.95 mg/L Cystatin C ≤ 0.95 mg/L Age; EF; serum cystatin C; hs-CRP; TFG. Risk of cardiovascular events or cardiovascular death: Multivariate analysis: RR = 1,91 (1,03-3,53), p = 0,03 Windhausen et al., 2009 5 1 st tertile (< 0.86 mg/L) 2 nd tertile (0.86-1.01 mg/L) 3 rd tertile (> 1.01 mg/L) Age > 65 years; sex; hypertension; DM; smoking; hypercholesterolemia; history of CAD; history of MI; PCI or myocardial revascularization; use of aspirin; use of beta-blockers; use or ACE inhibitors before randomization; NT-proBNP ≥ 1170 ng/L in men and ≥ 2150 ng/L in women; CRP ≥ 10 mg/L; cardiac troponin ≥ 0,3 μg/L; ST segment deviation ≥ 0,1 mV in ECG ad admission. Risk of mortality death: Univariate analysis: 2 nd tertile x 1st tertile: OR = 1.81 (0.89-3.67) 3 rd tertile x 1 st tertile: OR = 4.07 (2.16-7.66). p < 0.001 Multivariate analysis: 2 nd tertile x 1 st tertile: OR = 1.41 (0.68-2.94) 3 rd tertile x 1 st tertile: OR = 2.04 (1.02-4.10). p = 0.004 Risk of cardiovascular event: Univariate analysis: 2 nd tertile x 1 st tertile: OR = 1.26 (0.67-2.35) 3 rd tertile x 1 st tertile: OR = 2.06 (1.17-3.63). p = 0.01 Multivariate analysis: 2 nd tertile x 1 st tertile: OR = 1.32 (0.70-2.50) 3 rd tertile x 1 st tertiile: OR = 1.95 (1.05-3.63). p = 0.04 BNP: B-type natriuretic peptide; CK-MB: Creatine kinase isoenzyme MB; CAD: Coronary artery disease; CVD: cardiovascular disease; DM: Diabetes mellitus; CKD: Chronic kidney disease; ECG: Electrocardiography; EF: ejection fraction; LVEF: left ventricular ejection fraction; HDL: high-density lipoprotein; CHF: congestive heart failure; PCI: percutaneous coronary intervention; ACE: angiotensin-converting-enzyme; MI: myocardial infarction; BMI: body mass index; IMR: Index of microcirculatory resistance; KF: kidney failure; LDL: low density lipoprotein; NA: not applicable; NT-proBNP: N-terminal pro–B-type natriuretic peptide; BTP: beta-trace protein; CRP: C reactive protein; GFR: glomerular filtration rate; hs-CRP: high-sensitivity C reactive protein. CKD: chronic kidney disease. significant association was found between increased cystatin C levels and the development of cardiovascular events and mortality, suggesting that such association is independent of patients’ kidney function. However, 7 studies did not include GFR or serum creatinine in the multivariate analysis or did not perform this analysis. Iin this case, a poor patient prognosis may result from kidney dysfunction rather from increased cystatin C levels, since several studies have demonstrated that kidney dysfunction is associated with cardiovascular events and mortality. Only studies that performed multivariate analysis including GFR or serum creatinine were included in this meta-analysis. We found that the association between