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Published on: January 28, 2020
Additive prognostic value of gamma-glutamyltransferase in coronary artery disease
Michele Emdin1, Claudio Passino, Claudio Michelassi
1Cardiovascular Medicine Department, Foundation G. Monasterio, CNR-Regione Toscana, Pisa, Italy. emdin@ifc.cnr.it
Insights
Serum gamma-glutamyltransferase (GGT) activity is an independent risk factor for cardiovascular disease. Combining GGT, C-reactive protein (CRP), and fasting glucose identifies high-risk patients and those with the lowest cardiac death risk.
Area of Science:
- Cardiology
- Biomarkers
- Risk Stratification
Background:
- Serum gamma-glutamyltransferase (GGT) activity is a recognized independent cardiovascular risk factor.
- Previous studies have not compared GGT with C-reactive protein (CRP) and other markers in a multimarker strategy for coronary artery disease (CAD).
Purpose of the Study:
- To evaluate the independent prognostic value of GGT in patients with established CAD.
- To compare GGT with CRP and other traditional risk factors.
- To assess the additive prognostic value of GGT, CRP, and fasting glucose.
Main Methods:
- Prospective evaluation of 474 patients with angiographically documented CAD.
- Measurement of GGT, CRP, and traditional clinical/humoral parameters at hospital admission.
- Multivariate analysis to predict all-cause and cardiac mortality over 3 years.
Main Results:
- GGT demonstrated independent prognostic value, even after adjusting for confounders and established risk factors like CRP.
- Patients with higher GGT (>25 U/L) had significantly higher 3-year cardiac mortality (9% vs. 3.5%).
- A combination of elevated GGT, CRP, and fasting glucose identified a high-risk subgroup with 26.6% cardiac death rate.
Conclusions:
- GGT is confirmed as an independent risk factor in patients with established coronary artery disease.
- GGT, CRP, and fasting glucose exhibit additive prognostic value.
- Low levels of these biomarkers identify a low-risk patient subset.
Background:
Serum gamma-glutamyltransferase activity (GGT) has been documented as an independent cardiovascular risk factor. However, to-date its value has not been compared with C-reactive protein (CRP) and other indexes in a multimarker prognostic strategy in patients with coronary artery disease.
Methods:
We prospectively evaluated 474 subjects with angiographically documented CAD. GGT and traditional humoral and clinical parameters were measured at hospital admission. A multivariate model was used to predict all-cause and cardiac mortality.
Results:
GGT showed an independent prognostic value after adjustment for possible confounders, including alcohol consumption, and beyond established risk factors, such as extent of coronary atherosclerotic disease, left ventricular ejection fraction, age, serum glucose, cholesterol subfractions, and C-reactive protein (CRP). At a 3-year follow-up, cardiac mortality was 9% in patients with serum GGT activity >25 U/L vs. 3.5% in those with serum GGT<25 U/L (p=0.028). The association of three independent biomarkers (higher GGT, CRP, fasting glucose) identified a subgroup of 45 patients with the highest risk of cardiac death at 3 years (26.6%, vs. no event or 2.7% in the subsets of 87 and 198 patients with, respectively, no/one risk factor above cut-off value, p<0.0001).
Conclusions:
GGT is confirmed as independent risk factor in patients with established coronary artery disease. GGT, CRP, fasting glucose show an additive prognostic value, whereas low values of these biomarkers identify a subset of patients with the lowest risk of cardiac death.
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