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

Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark.
Journal of the American College of Cardiology (Impact Factor: 16.5). 07/2012; 60(4):339-45. DOI: 10.1016/j.jacc.2012.04.017
Source: PubMed


The aim of this study was to investigate the prognostic role of neutrophil gelatinase-associated lipocalin (NGAL) in a large population of patients with ST-segment elevation myocardial infarction.
NGAL is a glycoprotein released by damaged renal tubular cells and is a sensitive maker of both clinical and subclinical acute kidney injury. New data have demonstrated that NGAL is also stored in granules of mature neutrophils, and recent data suggest that NGAL may also be involved in the development of atherosclerosis. NGAL is significantly increased in patients with myocardial infarction compared with patients with stable coronary artery disease and healthy subjects. However, the prognostic value of NGAL has never been studied in patients with myocardial infarction.
We included 584 consecutive ST-segment elevation myocardial infarction patients admitted to the heart center of Gentofte University Hospital, Denmark, and treated with primary percutaneous coronary intervention, from September 2006 to December 2008. Blood samples were drawn immediately before primary percutaneous coronary intervention. 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 myocardial infarction or heart failure. The median follow-up time was 23 months (interquartile range, 20 to 24 months).
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 to 3.44; p = 0.01 and hazard ratio: 1.51; 95% confidence interval: 1.00 to 2.30; p = 0.05, respectively).
High plasma NGAL independently predicts all-cause mortality and MACE in ST-segment elevation myocardial infarction patients treated with primary percutaneous coronary intervention.

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    • "Several other new markers of renal function have been described, including neutrophil gelatinase associated lipocalin (NGAL), predicting mortality in heart failure patients, with and without chronic kidney disease [26], and adverse cardiac events in ST segment elevation myocardial infarction patients treated with primary percutaneous coronary intervention [27]. NGAL is a glycoprotein released by the damaged renal tubular cells and a marker of clinical and subclinical acute kidney injury [27] and in-hospital mortality in the emergency department, enabling clinicians to distinguish between chronic and early reversible kidney damage and to identify patients needing renal replacement therapy [28]. No study addressed yet the relation between NGAL and ventricular arrhythmia risk. "
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    ABSTRACT: Sudden cardiac death continues to be a major public health problem. Ventricular arrhythmia is a main cause of sudden cardiac death. The present review addresses the links between renal function tests, several laboratory markers, and ventricular arrhythmia risk in patients with renal disease, undergoing or not hemodialysis or renal transplant, focusing on recent clinical studies. Therapy of hypokalemia, hypocalcemia, and hypomagnesemia should be an emergency and performed simultaneously under electrocardiographic monitoring in patients with renal failure. Serum phosphates and iron, PTH level, renal function, hemoglobin and hematocrit, pH, inflammatory markers, proteinuria and microalbuminuria, and osmolarity should be monitored, besides standard 12-lead ECG, in order to prevent ventricular arrhythmia and sudden cardiac death.
    BioMed Research International 05/2014; 2014. DOI:10.1155/2014/509204 · 2.71 Impact Factor
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    • "NGAL levels significantly increase in both rats and patients post-MI and associate with adverse outcomes [59]. High plasma NGAL before intervention has been shown to independently predict all-cause mortality for MI patients treated with primary percutaneous coronary intervention [60]. The NGAL mechanisms of regulating LV remodeling have not been revealed, but may involve both direct interactions with MMP-9 as well as growth factor functions independent of complex formation. "
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    ABSTRACT: Polymorphonuclear granulocytes (PMNs; neutrophils) serve as key effector cells in the innate immune system and provide the first line of defense against invading microorganisms. In addition to producing inflammatory cytokines and chemokines and undergoing a respiratory burst that stimulates the release of reactive oxygen species, PMNs also degranulate to release components that kill pathogens. Recently, neutrophil extracellular traps have been shown to be an alternative way to trap microorganisms and contain infection. PMN-derived granule components are also involved in multiple non-infectious inflammatory processes, including the response to myocardial infarction (MI). In this review, we will discuss the biological characteristics, recruitment, activation, and removal of PMNs, as well as the roles of PMN-derived granule proteins in inflammation and innate immunity, focusing on the MI setting when applicable. We also discuss future perspectives that will direct research in PMN biology.
    Fibrogenesis & Tissue Repair 06/2013; 6(1):11. DOI:10.1186/1755-1536-6-11
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    ABSTRACT: Neutrophil Gelatinase-Associated Lipocalin (NGAL) is a sensitive marker of acute kidney injury. It is considered as a novel biomarker for progressive inflammatory process in patients with coronary artery disease. The aim of this study was to evaluate the prognostic significance of NGAL in predicting the in-hospital complications in patients with STEMI treated with fibrinolytic therapy. A total of 52 patients with STEMI treated with fibrinolytic therapy (reteplase) were investigated. Patients with high NGAL (group I) showed significantly higher mortality compared to those with low NGAL (group 2) p = 0.013. By logistic regression shock and pulmonary edema were very strongly correlated with increased NGAL level with a ratio of 0.842, 0.608 and p = 0.0001, respectively. In conclusions, cardiovascular death and in-hospital complications were significantly higher in patients with high NGAL than those with low NGAL. Plasma NGAL is a significant predictor of mortality and in hospital complications in patients with STEMI.
    Research Journal of Cardiology 01/2013; 6(1):10-18. DOI:10.3923/rjc.2013.10.18
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