Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway.
Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.
Int J Cardiol. 2018 Jul 1;262:79-84. doi: 10.1016/j.ijcard.2018.03.028. Epub 2018 Mar 8.
Circulating neutrophil gelatinase-associated lipocalin (NGAL) concentration increases in cardiovascular disease, but the long-term prognostic value of NGAL concentration has not been evaluated in acute coronary syndrome (ACS). We examined the association between NGAL concentration and prognosis in patients with ACS after non-ST-elevation myocardial infarction (NSTEMI) or STEMI.
NGAL concentration was measured in blood from 1121 consecutive ACS patients (30% women, mean age 65 years) on the first morning after admission. After adjustment for 14 variables, NGAL concentration predicted long-term (median 167 months) mortality (hazard ratio [HR] 1.33, 95% confidence interval [CI] 1.10-1.61, P = 0.003) for quartile (q) 4 of NGAL concentration. NGAL concentrations also predicted long-term mortality (HR = 1.63, 95% CI 1.31-2.03, P < 0.001, N = 741) when adjusting for Global Registry of Acute Coronary Events (GRACE) score, left ventricular ejection fraction (LVEF), and pro-B-type natriuretic peptide (proBNP) and C-reactive protein (CRP) concentrations. With these adjustments, NGAL concentration predicted long-term mortality in NSTEMI patients (HR = 2.02, 95% CI 1.50-2.72, P < 0.001) but not in STEMI patients (HR = 1.32, 95% CI 0.95-1.83, P = 0.100). In all patients, the combination of NGAL concentration and GRACE score yielded an HR of 5.56 (95% CI 4.37-7.06, P < 0.001) for q4/q4 for both variables.
NGAL concentration in ACS is associated with long-term prognosis after adjustment for clinical confounders. Measuring circulating NGAL concentration may help to identify patients-particularly those with NSTEMI-needing closer follow-up after ACS.
循环中性粒细胞明胶酶相关脂质运载蛋白（NGAL）浓度在心血管疾病中增加，但 NGAL 浓度在非 ST 段抬高型心肌梗死（NSTEMI）或 ST 段抬高型心肌梗死（STEMI）后的急性冠状动脉综合征（ACS）患者中的长期预后价值尚未得到评估。我们研究了 ACS 患者入院后第一个早晨血液中 NGAL 浓度与预后之间的关系。在调整了 14 个变量后，NGAL 浓度预测了长期（中位 167 个月）死亡率（风险比 [HR] 1.33，95%置信区间 [CI] 1.10-1.61，P=0.003）四分位数（q）4 的 NGAL 浓度。当调整全球急性冠状动脉事件注册（GRACE）评分、左心室射血分数（LVEF）以及前 B 型利钠肽（proBNP）和 C 反应蛋白（CRP）浓度后，NGAL 浓度也预测了长期死亡率（HR=1.63，95%CI 1.31-2.03，P<0.001，N=741）。经过这些调整，NGAL 浓度在 NSTEMI 患者中预测了长期死亡率（HR=2.02，95%CI 1.50-2.72，P<0.001），但在 STEMI 患者中则没有（HR=1.32，95%CI 0.95-1.83，P=0.100）。在所有患者中，NGAL 浓度和 GRACE 评分的组合在两个变量的 q4/q4 时产生了 5.56（95%CI 4.37-7.06，P<0.001）的 HR。
ACS 中的 NGAL 浓度与调整后的临床混杂因素后的长期预后相关。测量循环 NGAL 浓度可能有助于识别需要更密切随访的 ACS 患者，尤其是 NSTEMI 患者。
