Urinary neutrophil gelatinase-associated lipocalin and clinical outcomes in patients with acute coronary syndrome: a focus on patients with impaired ejection fraction.

IF 2.2 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Coronary artery disease Pub Date : 2026-10-16 DOI:10.1097/MCA.0000000000001682

Yodo Gatate, Mitsunobu Nagai, Keisuke Matsuo, Hiroki Hoya, Saki Hasegawa-Tamba, Michiru Nomoto, Takahide Arai, Shintaro Nakano

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引用次数: 0

Abstract

Background: To evaluate the prognostic value of urinary neutrophil gelatinase-associated lipocalin (NGAL) normalized to creatinine in patients with acute coronary syndrome (ACS), focusing on left ventricular ejection fraction (LVEF).

Methods: This retrospective cohort study included 144 patients emergently admitted for ACS, with urinary NGAL measured 4-48 h postadmission. Primary and secondary outcomes were all-cause mortality and major adverse cardiovascular and cerebrovascular events (MACCEs), respectively. Optimal NGAL/creatinine cutoffs were determined using receiver operating characteristic analysis. Associations between urinary NGAL/creatinine and clinical outcomes were evaluated using Cox proportional hazards models.

Results: During a median 734.5-day follow-up, 8 deaths and 44 MACCE occurred. The optimal NGAL/creatinine cutoff for predicting MACCE was 20.85 ng/mg creatinine. All deaths occurred in the high NGAL/creatinine group (≥20.85), but mortality analyses were limited by statistical separation. High NGAL/creatinine was significantly associated with MACCE (hazard ratio = 3.47, 95% confidence interval = 1.61-7.47) and remained associated with a higher event hazard after adjustment for age, brain natriuretic peptide, LVEF, and estimated glomerular filtration rate (adjusted hazard ratio = 2.75; P = 0.017). In subgroup analyses, the area under the curve for MACCE was numerically higher in patients with LVEF <50% than in those with LVEF ≥50% (0.753 vs. 0.581). Formal interaction testing in the Cox model, however, did not demonstrate significant effect modification by LVEF category (P for interaction = 0.100).

Conclusion: Urinary NGAL/creatinine was significantly associated with long-term MACCE in patients with ACS. Although subgroup analyses showed numerically different associations according to LVEF, formal interaction testing did not demonstrate significant effect modification by LVEF.

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尿中性粒细胞明胶酶相关脂钙蛋白与急性冠状动脉综合征患者的临床结局：专注于射血分数受损的患者

背景：评价尿中性粒细胞明胶酶相关脂钙蛋白（NGAL）归一化为肌酐在急性冠脉综合征（ACS）患者中的预后价值，重点关注左心室射血分数（LVEF）。方法：本回顾性队列研究纳入144例急诊ACS患者，入院后4-48小时测量尿NGAL。主要和次要结局分别是全因死亡率和主要不良心脑血管事件（MACCEs）。利用受试者工作特性分析确定最佳NGAL/肌酐截止值。使用Cox比例风险模型评估尿NGAL/肌酐与临床结果之间的关系。结果：在中位734.5天的随访期间，发生8例死亡和44例MACCE。预测MACCE的最佳NGAL/肌酐临界值为20.85 ng/mg肌酐。所有死亡发生在高NGAL/肌酐组（≥20.85），但死亡率分析受到统计分离的限制。高NGAL/肌酐与MACCE显著相关（风险比= 3.47,95%可信区间= 1.61-7.47），在调整年龄、脑利钠肽、LVEF和肾小球滤过率后，仍与较高的事件风险相关（调整风险比= 2.75;P = 0.017）。在亚组分析中，LVEF患者的MACCE曲线下面积数值更高。结论：尿NGAL/肌酐与ACS患者的长期MACCE显著相关。虽然亚组分析显示LVEF在数值上有不同的关联，但正式交互检验并未显示LVEF对效果的显著改变。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Coronary artery disease 医学-外周血管病

CiteScore

2.50

自引率

0.00%

发文量

190

审稿时长

6-12 weeks

期刊介绍： Coronary Artery Disease welcomes reports of original research with a clinical emphasis, including observational studies, clinical trials, translational research, novel imaging, pharmacology and interventional approaches as well as advances in laboratory research that contribute to the understanding of coronary artery disease. Each issue of Coronary Artery Disease is divided into four areas of focus: Original Research articles, Review in Depth articles by leading experts in the field, Editorials and Images in Coronary Artery Disease. The Editorials will comment on selected original research published in each issue of Coronary Artery Disease, as well as highlight controversies in coronary artery disease understanding and management. Submitted artcles undergo a preliminary review by the editor. Some articles may be returned to authors without further consideration. Those being considered for publication will undergo further assessment and peer-review by the editors and those invited to do so from a reviewer pool.