APPLICATION OF BIOLOGICAL MARKERS OF KIDNEY INJURY FOR PROGNOSIS OF LONG-TERM ADVERSE OUTCOMES IN PATIENTS WITH ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION
O.L. Barbarash1,2, I.S. Bykova1, V.V. Kashtalap1,2, M.V. Zykov1, O.N. Khryachkova1, V.V. Kalaeva1, K.S. Shafranskaya1, V.N. Karetnikova1,2
1Research Institute for Complex Issues of Cardiovascular Diseases SB RAMS, 650002, Kemerovo, Sosnovy Blvd., 6
2Kemerovo State Medical Academy of Minzdrav of Russia, 650039, Kemerovo, Voroshilov str., 22A
Keywords: NGAL, myocardial infarction, renal dysfunction, prognosis, NGAL
Abstract
Objective: To study the prognostic significance of serum NGAL (sNGAL) and cystatin C in the acute phase of ST-segment elevation myocardial infarction (STEMI) in the late disease period. Material and Methods: 357 patients with STEMI, admitted to hospital within 24 h of symptom onset, were included in the study. Serum creatinine levels with the calculation of glomerular filtration rate (GFR) using the MDRD as well as levels of sNGAL and cystatin C were measured on day 1 and 12-14. Results: All patients were divided into 2 groups according to their estimated GFR: with and without renal dysfunction (RD), defined as a decrease of GFR < 60 ml/min/1.73 m
2. Within 3 years of follow-up, the composite endpoint (CEP) were assessed (CEP - death + non-fatal cardiovascular events). The ROC curve analysis was used to determine the thresholds for every biomarker, involved in the CEP development: NGAL (≥ 1.25 ng / ml) and cystatin C (≥ 1.9 mg / l). On day 12-14 of hospitalization elevated NGAL ≥ 1.25 ng / mL was associated with a 3-fold increased risk for adverse cardiovascular events in a 3-year follow up after STEMI; whereas, elevated cystatin C ≥ 1.9 mg/l - with a 2-fold increased risk for the CEP, and signs of RD, found in patients before the discharge from the hospital, - with a 1.5-fold increased cardiovascular risk. The model considering an increase of NGAL over 1.25 ng / l has the highest prognostic value, while the models based on the levels of cystatin C and GFR are of equal prognostic value. Conclusion: The most promising issue in the prognosis of long-term adverse outcomes in patients with STEMI may be considered the assessment of RD using new biomarkers such as sNGAL.
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