Cystatin-C as a potential risk factor for acute myocardial infarction with normal renal function

Background: Myocardial Infarction accounts for 20% of all medical emergency admissions and has the highest risk for adverse effects and deaths. Risk of CAD could be prevented by various strategies and most of the developed countries could reduce the incidence and mortality related to CAD especially Myocardial Infarction by various preventive methods. Cystatin-C thus acts as an independent risk factor for Myocardial Infarction and heart failure. Aim and objective: To estimate the Serum level of Cystatin-C in Acute Myocardial Infarction with normal renal function Materials and methods: The study included 40 patients admitted in the medicine ward of RMMCH. The study period was from February 2018- July 2018. Patients with acute coronary syndromes were identified over a period according to the criteria and were included in the study. Primary complaints like angina, dyspnea, symptoms of cardiac failure were recorded. Risk factors for coronary artery disease like diabetes mellitus, systemic hypertension, smoking, hyperlipidemia, renal failure, and other complaints if any were noted. Clinical examination included a detailed general examination including vital signs and systemic examination of cardiac, respiratory, gastrointestinal, and nervous systems. 2 ml of blood was withdrawn from all patients within 12 hours of onset of symptoms for measuring Cystatin-C. Results: The common age was 52 to 59 years (47.5%) and 45 to 51 years (45.0%). The mean age of the study patients was 51.10 ±5.47 years. The majority of the patients had ST-elevated MI (N=27, 67.5%). Among STEMI, 14 patients were AWMI (N=14, 51.9%) IWMI- STEMI was identified in 18.5% patients. Likewise, posterior wall MI-STEMI was the diagnosis for 18.5% and Inferior-lateral-STEMI was the feature for 11.1%. The mean Cystatin-C for STEMI was 1.24 + 0.26 whereas it was 1.38 ± 28 for NSTEMI. The difference was statistically insignificant (t=1.46, p=151). The overall Cystatin-C Mean was 1.29 ± .27, which was higher than the normal level. The correlation of Cystatin-C with LV function is poor (r = .181, p=26). The relationship was weakly positive and insignificant. That was when Cystatin ‘C' was more, LV function was less and vice-versa. The correlation of Cystatin-C with TIMI was negative i.e. when Cystatin was more, TIMI was less and vice-versa but the relationship was poor (r=.126, p = .44) and insignificant. Conclusion: Cystatin-C plays an important role in the pathogenesis of Acute Myocardial Infarction, and one of the mechanisms is thought to be that Cystatin-C facilitates the progress of atherosclerosis by regulating inflammation. Cystatin-C is less influenced by age, gender, and muscle mass and thus may be a better indicator of cardiovascular risk especially Myocardial Infarction.