Prognostic impact of neutrophil gelatinase-associated lipocalin and B-type natriuretic in patients with ST-elevation myocardial infarction treated by primary PCI: a prospective observational cohort study

Katerina Helanova, Simona Littnerova, Petr Kubena, Eva Ganovska, Marie Pavlusova, Lenka Kubkova, Jiri Jarkovsky, Monika Pavkova Goldbergova, Jolana Lipkova, Jana Gottwaldova, Petr Kala, Ondrej Toman, Milan Dastych, Jindrich Spinar, Jiri Parenica, Katerina Helanova, Simona Littnerova, Petr Kubena, Eva Ganovska, Marie Pavlusova, Lenka Kubkova, Jiri Jarkovsky, Monika Pavkova Goldbergova, Jolana Lipkova, Jana Gottwaldova, Petr Kala, Ondrej Toman, Milan Dastych, Jindrich Spinar, Jiri Parenica

Abstract

Objectives: Neutrophil gelatinase-associated lipocalin (NGAL) from a pathophysiological perspective connects various pathways that affect the prognosis after myocardial infarction. The objective was to evaluate the benefits of measuring NGAL for prognostic stratification in addition to the Thrombolysis in Myocardial Infarction (TIMI) score, and to compare it with the prognostic value of B-type natriuretic peptide (BNP).

Design: Prospective observational cohort study.

Setting: One university/tertiary centre.

Participants: A total of 673 patients with ST segment elevation myocardial infarction were treated by primary percutaneous coronary intervention. NGAL and BNP were assessed on hospital admission.

Primary outcome: 1-year mortality.

Secondary outcomes: 1-year hospitalisation due to acute heart failure, unplanned revascularisation, reinfarction, stroke and combined end point of 1-year mortality and hospitalisation due to heart failure.

Statistical methods: Using the c-statistic, the ability of NGAL, BNP and TIMI score to predict 1-year mortality alone and in combination with readmission for heart failure was evaluated. The addition of the predictive value of biomarkers to the score was assessed by category free net reclassification improvement (cfNRI) and the integrated discrimination index (IDI).

Results: The NGAL level was significantly higher in non-survivors (67 vs 115 pg/mL; p<0.001). The area under the curve (AUC) values for mortality prediction for NGAL, BNP and TIMI score were 75.5, 78.7 and 74.4, respectively (all p<0.001) with optimal cut-off values of 84 pg/mL for NGAL and 150 pg/mL for BNP. The addition of NGAL and BNP to the TIMI score significantly improved risk stratification according to cfNRI and IDI. A BNP and the combination of the TIMI score with NGAL predicted the occurrence of the combined end point with an AUC of 80.6 or 82.2, respectively. NGAL alone is a simple tool to identify very high-risk patients. NGAL >110 pg/mL was associated with a 1-year mortality of 20%.

Conclusions: The measurement of NGAL together with the TIMI score results in a strong prognostic model for the 1-year mortality rate in patients with STEMI.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Figures

Figure 1
Figure 1
Reclassification of 1-year mortality risk for death in patients with the addition of BNP, NGAL and BNP+NGAL to the TIMI score model. The addition of the predictive value of biomarkers to the TIMI score was assessed by cfNRI and the IDI. BNP, B-type natriuretic peptide; cfNRI, category free net reclassification improvement; IDI, integrated discrimination index; NGAL, neutrophil gelatinase-associated lipocalin; TIMI, thrombolysis in myocardial infarction.
Figure 2
Figure 2
One-year mortality in groups of patients stratified according to the NGAL levels, BNP levels on admission and TIMI risk score. BNP, B-type natriuretic peptide; NGAL, neutrophil gelatinase-associated lipocalin; TIMI, thrombolysis in myocardial infarction.

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