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Prognostic Utility of Neutrophil Gelatinase–Associated Lipocalin in Predicting Mortality and Cardiovascular Events in Patients With ST-Segment Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention
Study Questions:
What is the prognostic role of neutrophil gelatinase–associated lipocalin (NGAL) in a large population of patients with ST-segment elevation myocardial infarction (STEMI)?
Methods:
The investigators included 584 consecutive STEMI patients admitted to a single high-volume invasive heart center, treated with primary percutaneous coronary intervention (PPCI), from September 2006 to December 2008. Blood samples were drawn immediately before PPCI. Plasma NGAL levels were measured using a time-resolved immunofluorometric assay. The endpoints were all-cause mortality (n = 69) and the combined endpoints (n = 116) of major adverse cardiac events (MACE) defined as cardiovascular mortality and admission due to recurrent MI or heart failure. The median follow-up time was 23 months (interquartile range, 20-24 months).
Results:
Patients with high NGAL (>75th percentile) had increased risk of all-cause mortality and MACE compared with patients with low NGAL (log-rank test, p < 0.001). After adjustment for confounding risk factors chosen by backward elimination by Cox regression analysis, high NGAL remained an independent predictor of all-cause mortality and MACE (hazard ratio, 2.00; 95% confidence interval, 1.16-3.44; p = 0.01 and hazard ratio, 1.51; 95% confidence interval, 1.00-2.30; p = 0.05, respectively).
Conclusions:
The authors concluded that high plasma NGAL independently predicts all-cause mortality and MACE in STEMI patients treated with PPCI.
Perspective:
The present study reports that high NGAL is an independent predictor of all-cause mortality and cardiovascular events in patients with STEMI treated with PPCI, even after adjusting for conventional risk factors, renal function, and other significant baseline values. Further prospective multicenter studies are indicated to assess whether this is mediated by acute kidney injury, increased inflammation, or both, and whether plaque rupture in those with NGAL may also contribute to the higher event rate.
Keywords: Inflammation, Myocardial Infarction, Follow-Up Studies, Acute Kidney Injury, Risk Factors, Angioplasty, Percutaneous Coronary Intervention, Lipocalins, Fluoroimmunoassay, Prognosis, Biomarkers, Coronary Angiography, Heart Failure, Cardiac Volume, Cardiovascular Diseases, Carrier Proteins
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