Abstract
BackgroundThe aim of this study was to assess significance of serum neutrophil gelatinase-associated lipocalin (sNGAL) and cystatin C (sCC) in prediction of adverse cardiovascular outcome after ST-segment elevation myocardial infarction (STEMI).MethodsWe recruited 357 consecutive patients who were admitted to the hospital within 24 h after onset of STEMI. On the 1st and 12th-14th day after hospital admission, we measured levels of sNGAL and sCC. We also determined presence of renal dysfunction (RD), defined as glomerular filtration rate < 60 mL/min/1.73 m2. After 3 years of follow-up, we performed a logistic regression and assessed the value of RD, sNGAL, and sCC in prediction of combined endpoint, defined as cardiovascular death or any cardiovascular complication.ResultsRD, sCC level ≥ 1.9 mg/L, and sNGAL level ≥ 1.25 ng/mL on the 12th-14th day of hospitalization were associated with a 1.6-fold, 1.9-fold, and 2.9-fold higher risk of adverse cardiovascular outcome, respectively. Area under the ROC curve was the highest for the model based on sNGAL level compared to the models based on sCC level or RD presence.ConclusionsMeasurement of sNGAL level in patients with STEMI on the 12th-14th day after hospital admission may improve prediction of adverse cardiovascular outcome.
Highlights
The aim of this study was to assess significance of serum neutrophil gelatinase-associated lipocalin and cystatin C in prediction of adverse cardiovascular outcome after ST-segment elevation myocardial infarction (STEMI)
The criteria of inclusion into the study were 1) age > 18 years; 2) diagnosis of STEMI according to the European Society of Cardiology (ESC) Guidelines [16]; 3) written informed consent to participate in the study
We identified anterior MI, left ventricular ejection fraction (LVEF) < 40%, 3 affected coronary arteries, past medical history of stroke, level of serum cystatin C (sCC) ≥ 1.9 mg/L on the 12th14th day after hospital admission, level of serum neutrophil gelatinase-associated lipocalin (sNGAL) ≥ 1.25 ng/mL on the 12th-14th day after hospital admission, and renal dysfunction (RD) before hospital discharge as the factors significantly associated with an adverse cardiovascular outcome after 3 years of follow-up (Table 6)
Summary
The aim of this study was to assess significance of serum neutrophil gelatinase-associated lipocalin (sNGAL) and cystatin C (sCC) in prediction of adverse cardiovascular outcome after ST-segment elevation myocardial infarction (STEMI). A number of investigations revealed a significant association of renal dysfunction [RD, defined as glomerular filtration rate (GFR) < 60 mL/min/1.73 m2] with a high risk of cardiovascular death or acute cardiovascular events [2,3,4]. A critical decrease in GFR and albuminuria commonly occur at the late stage of chronic kidney disease (CKD) when > 30% of nephrons are affected [6]. Serum cystatin C (sCC) and serum neutrophil gelatinase-associated lipocalin (sNGAL) were suggested as the promising candidates [7, 8]
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