Log in to MyACC
Galectin-3 and Outcomes After MI
Study Questions:
What is the prognostic value of galectin-3 (Gal-3) in patients with acute myocardial infarction (AMI)?
Methods:
The authors measured Gal-3, a marker of myocardial remodeling and fibrosis, in 1,342 patients (mean age 67 years, 61% male) admitted for a first-ever AMI (79% with non–ST-segment elevation MI, % revascularized unspecified) at Mayo Clinic hospitals in Olmsted County, MN, from 2002 to 2012. Patients were then followed (mean follow-up of 5.4 ± 3.5 years) for incident heart failure (HF) (defined by International Classification of Diseases, Ninth Revision, code and ejection fraction [EF] on echocardiogram) and death, classified as cardiovascular or noncardiovascular based on death certificates. They performed survival analyses and derived risk discrimination metrics to assess the prognostic value of adding Gal-3 and to risk prediction models for death, cardiovascular death, HF, HF with reduced EF (HFrEF), and HF with preserved EF (HFpEF).
Results:
One third of patients had elevated Gal-3 compared to reference value (22.1 ng/ml). Patients with higher Gal-3 were more likely to be women, to be older, and to have more comorbidities than patients with lower Gal-3. Patients in the highest tertile of Gal-3 (>22.4 ng/ml) had a five- to seven-fold higher risk of death, cardiovascular death, HF, HFrEF, and HFpEF. The estimates were significantly attenuated to a two-fold increase in risk after adjustment for age, sex, Charlson comorbidity index, peak troponin, and prior history of HF, and down to 1.6-fold after adjustment for soluble suppression of tumorigenicity 2 (sST-2) levels, another marker of fibrosis. Risk discrimination metrics showed minimal improvement in C-statistic for death (Δ0.02) and HF (Δ0.01) after addition of Gal-3 to the reference model.
Conclusions:
The authors concluded that Gal-3 is associated with death and HF post-AMI.
Perspective:
Improving our ability to predict risk relies on using novel biomarkers that reflect processes not accounted for by traditional factors. Gal-3 and sST2 are markers of fibrosis and potential candidates. This study corroborates previous findings suggesting that Gal-3 is associated with outcomes in other clinical settings. However, no other substantial conclusions can be drawn. Risk prediction metrics were minimally changed; in multivariable analyses, the estimates were significantly dampened, and major prognostic factors such as diabetes mellitus, hypertension, estimated glomerular filtration rate, and B-type natriuretic peptide levels—all strong markers of risk which differed between Gal-3 tertiles—were not included in the multivariable models. Whether Gal-3 offers significantly more information on risk than routinely collected data remains unclear. Biomarker studies in the context of management strategies are needed to define a role for Gal-3 and other potential candidates of risk in personalizing therapy.
Keywords: Acute Coronary Syndrome, Biomarkers, Comorbidity, Fibrosis, Galectin 3, Heart Failure, International Classification of Diseases, Myocardial Infarction, Myocardium, Risk, Secondary Prevention, Stroke Volume, Troponin
< Back to Listings
