Gamma-glutamyl transferase and prognosis in patients with coronary artery disease
Introduction
Gamma-glutamyl transferase (GGT) is a reliable marker of hepatobiliary disease and alcohol abuse [1]. Over the last 2 decades ample evidence showed that elevated activity of GGT may serve as a risk marker for coronary artery disease (CAD) as well. Epidemiological evidence strongly suggests that elevated activity of circulating GGT is associated with incident CAD [2], [3] and predicts all-cause and cardiovascular mortality in unselected populations [4], [5] and patients with known CAD [6], [7], [8]. Catalytically active GGT is found in atherosclerotic plaques [9] and intra-plaque GGT activity was closely correlated with systemic GGT activity [10] and histological markers of plaque instability [11]. These studies raised the possibility that GGT may be directly involved in atherosclerosis, plaque instability and coronary events. Despite numerous studies on the association of GGT with cardiovascular disease, several areas of uncertainty still remain. First, previous studies have shown that GGT is closely associated with cardiovascular and metabolic risk factors [2], [3], [5], [7]. Nevertheless, it remains unexplored whether GGT provides incremental information on top of the information provided by cardiovascular risk factors regarding mortality prediction [3]. Second, based on the assumption that patients with CAD mostly die from cardiac causes, the association between GGT and non-cardiac mortality has gained little attention in these patients. Evidence available, however, suggests that contribution of non-cardiac mortality to overall mortality among patients with CAD has increased probably due to the increased use and efficacy of secondary prevention strategies. A recent study of patients undergoing PCI has shown that in current era only 36.8% of deaths following PCI are of cardiac origin [12]. Furthermore it has been shown that PCI may abolish prognostic power of GGT [6]. Third, the association of GGT with the extent of coronary atherosclerosis [13], [14] or acute CAD events, in particular nonfatal myocardial infarction [3], [5] remains controversial. The aim of this study was 2-fold: first, we investigated the association between GGT and 3-year prognosis in a large series of patients with angiographic CAD after PCI, and; second, we assessed whether GGT provides incremental prognostic information on top of the information provided by cardiovascular and metabolic risk factors in patients with CAD.
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2. 1. Patients
The source sample included 6724 patients with CAD who underwent PCI in our institution between January 2000 and January 2011. To be included in the study, patients had to have angiography-confirmed CAD and GGT activity measurement(s) available. Patients with acute infections, malignancies, hepatobiliary disease or alcohol abuse (n = 971 patients) and those with cardiogenic shock (n = 252 patients) were excluded. Thus 5501 patients were included in this study. Of the 5501 patients included, 2967
3. 1. Baseline data
The study included 5501 patients. Patients were divided into subgroups according to GGT activity tertiles which were: 1st tertile (GGT < 28.10 U/L; n = 1866 patients), 2nd tertile (GGT ≥ 28.10 U/L to 49.50 U/L; n = 1804 patients) and 3rd tertile (GGT > 49.50 U/L; n = 1831 patients). Baseline data are shown in Table 1. With the exception of the extent of CAD and clinical presentation all other data differed among patients in different GGT tertiles. All patients received coronary stents. Drug-eluting stents were
4. Discussion
The main findings of this study can be summarized as follows: 1) In patients with CAD, elevated activity of circulating GGT was associated with an increased risk of all-cause, cardiac and non-cardiac mortality. 2) Elevated activity of GGT did not correlate with the extent of angiographic CAD and was not associated with increased risk of nonfatal myocardial infarction, stroke or stent thrombosis over 3 years after PCI. 3) GGT provided prognostic information that was incremental and beyond the
Funding
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Conflict of interest
None.
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Alkaline phosphatase and prognosis in patients with diabetes mellitus and ischemic heart disease
2022, Clinica Chimica ActaCitation Excerpt :This observational study included 1426 patients with IHD and DM who were treated with percutaneous coronary intervention (PCI) in 2 university hospitals in Munich, Germany, between 2000 and 2011. Characteristics of the source sample were reported in a prior publication.[18] To be included in the study, patients had to have IHD confirmed by coronary angiography (see below for the angiographic criteria of IHD) and ALP activity measurements available.
Gamma-glutamyl transferase and the risk of atherosclerosis and coronary heart disease
2018, Clinica Chimica ActaCitation Excerpt :In patients with GGT activity in the 1st, 2nd and 3rd tertiles, respective 3-year all-cause mortality was 7.1%, 7.2% and 13.9% and cardiac mortality was 4.1%, 3.6% and 7.9%. After adjustment, GGT was independently associated with a 30% (P < 0.001) and 21% (P = 0.005) increase in the adjusted risk of all-cause and cardiac mortality, respectively, for each standard deviation increment in log-GGT [98]. In another recent study of 2534 patients with acute coronary syndromes treated with percutaneous coronary intervention, we found a 24% increase (P = 0.002) in 3-year mortality for each standard deviation increment in log-GGT [99].
A comparison of gamma-glutamyl transferase and alkaline phosphatase as prognostic markers in patients with coronary heart disease
2018, Nutrition, Metabolism and Cardiovascular DiseasesCitation Excerpt :Elevated GGT or ALP might have been associated with the risk of myocardial infarction but the proportion of infarctions that ended fatally might have been counted (and reported) as deaths. This might have led to an attenuation of the association between GGT or ALP and the true myocardial infarction occurrence [7]. The current study has a number of limitations.
Gamma-glutamyl transferase and atrial fibrillation in patients with coronary artery disease
2017, Clinica Chimica ActaCitation Excerpt :The current study is a retrospective analysis of 5501 patients with angiography-proven CAD who underwent percutaneous coronary intervention between January 2000 and January 2011 in 2 German university hospitals. The characteristics of included patients and the source sample have been previously reported [10]. In brief, all patients had angiographically-confirmed CAD and baseline (admission) measurements of GGT available.
Relation of Gamma-Glutamyl Transferase to Cardiovascular Events in Patients with Acute Coronary Syndromes
2016, American Journal of CardiologyCitation Excerpt :Demonstration of the GGT activity in atherosclerotic plaques and its correlation with indexes of plaque instability and other lines of evidence supported the view that elevated level of GGT may serve as a biomarker to predict the increased risk of cardiac mortality. In a recent study, our group showed that GGT predicted long-term all-cause, cardiac, and noncardiac mortality in patients with angiography-proved CAD.13 Nevertheless, the study did not demonstrate an improvement in the discrimination of the risk prediction of cardiac mortality by GGT casting doubt on the ability of GGT to improve the risk prediction of cardiac mortality in contemporary patients with CAD.