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Published on: February 16, 2016
High admission levels of γ-glutamyltransferase predict poor myocardial perfusion after primary percutaneous
Uygar Cagdas Yuksel1, Turgay Celik, Murat Celik
1Department of Cardiology, School of Medicine, Gulhane Military Medical Academy, Etlik-Ankara, Turkey.
Insights
High admission serum gamma-glutamyltransferase levels are linked to poor myocardial perfusion in acute myocardial infarction patients undergoing primary percutaneous coronary intervention. This association is stronger with longer pain to balloon times, indicating increased oxidative stress.
Area of Science:
- Cardiology
- Biochemistry
- Medical Diagnostics
Background:
- Reperfusion injury and the no-reflow phenomenon in acute myocardial infarction (AMI) are linked to oxidative stress.
- Serum gamma-glutamyltransferase (GGT) is a marker of oxidative stress.
Purpose of the Study:
- To investigate the association between admission serum GGT levels and poor myocardial perfusion post-primary percutaneous coronary intervention (PCI) in AMI patients.
- To identify predictors of poor myocardial perfusion in this patient cohort.
Main Methods:
- Retrospective study of 80 AMI patients with pre-procedural Thrombolysis In Myocardial Infarction (TIMI) flow 0/1.
- Patients were divided into two groups based on post-primary PCI TIMI perfusion grades (0-1 vs. 2-3).
- Admission serum GGT, creatine kinase-MB (CK-MB), and pain to balloon time were analyzed.
Main Results:
- Patients with poor perfusion (TIMI grade 0-1) had significantly higher admission GGT and longer pain to balloon times.
- Univariate analysis showed associations between poor perfusion and pain to balloon time, GGT, peak CK-MB, and ejection fraction.
- Multivariate analysis identified pain to balloon time and GGT as independent predictors of poor myocardial perfusion.
Conclusions:
- Elevated admission serum GGT levels are associated with poor myocardial perfusion after primary PCI in AMI patients.
- The association between GGT and poor perfusion is particularly significant in patients with prolonged pain to balloon times.
- Serum GGT may serve as a useful biomarker for predicting reperfusion outcomes in AMI.
Objective:
This retrospective study aimed to investigate the relationship between admission levels of serum y-glutamyltransferase and poor myocardial perfusion after primary percutaneous coronary intervention in patients with acute myocardial infarction.
Introduction:
Reperfusion injury caused by free radical release and increased oxidative stress is responsible for the pathophysiology of the no-reflow phenomenon in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention. Serum γ-glutamyltransferase is an established marker of increased oxidative stress.
Methods:
The study population consisted of 80 patients (64 men and 16 women, mean age = 67.5 + 6.6 years) with thrombolysis in myocardial infarction 0/1 flow pre-procedurally. The patients were divided into two groups according to thrombolysis in myocardial perfusion grades that were assessed immediately following primary percutaneous coronary intervention. The two groups (group 1 and group 2) each consisted of 40 patients with thrombolysis in myocardial perfusion grades 0-1 and thrombolysis in myocardial perfusion grades 2-3, respectively.
Results:
Admission pain to balloon time, γ-glutamyltransferase and creatine kinase-MB isoenzyme levels of group 1 patients were significantly higher than those of group 2 patients. Pain to balloon time, γ-glutamyltransferase, peak creatine kinase-MB isoenzyme, low left ventricular ejection fraction and poor pre-procedural thrombolysis in myocardial infarction grade were significantly associated with poor myocardial perfusion by univariate analysis. However, only pain to balloon time and γ-glutamyltransferase levels showed a significant independent association with poor myocardial perfusion by backward logistic regression analysis. Adjusted odds ratios were calculated as 4.92 for pain to balloon time and 1.13 for γ-glutamyltransferase.
Conclusion:
High admission γ-glutamyltransferase levels are associated with poor myocardial perfusion in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention, particularly in patients with prolonged pain to balloon time.
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