Association Of Serum NGAL And The Severity Of Coronary Artery Disease In Patients With Non-ST-elevation Myocardial Infarction And Its Correlation With Prognosis

Objective:To investigate the correlation between serum neutrophil gelatinase-asso-ciated lipocalin(NGAL) and the severity with complexity of coronary artery disease in patients with non-ST-elevation myocardial infarction and its correlation with prognosis.Methods:According to the inclusion criteria, 47 NSTEMI patients and 45 patients(control group)confirmed with normal coronary arteries who undergo coronary angiography with suspected coronary artery disease hospitalized in our department of cardiology from June 2014 to June 2015 were enrolled in this study. The level of serum NGALwere analysis by ELISA method with the blood samples collected from the patitens on admission. Application of Grace risk score, SYNTAX and Gensini score to analysis the correlation between serum neutrophil gelatinase-associated lipocalin(NGAL) and the severity with complexity of coronary artery disease in patients with non-ST-elevation myocardial infarction. The patients with NSTEMI were followed up for 6 months and observed and recorded the patients with recurrent angina readmission and adverse cardiovascular events(including cardiac death, non fatal myocardial infarction, congestion heart failure, severe arrhythmia, revascularization).Results:(1) Compared the NSTEMI group with control group in clinical data, blood biochemical indexes and NGAL levels: there is no statistical differences in age, gender,hypertension, diabetes, smoking, serum creatinine, total cholesterol, high density lipoprotein between the two groups(P > 0.05),The level of triglyceride, low density lipoprotein, neutrophil count, leukocyte count, hs-CRP average was, LVEF was lower than the control group(P < 0.05), serum NGAL levels was significantly higher in the NSTEMI group compared to the control group(107.91 ± 50.14ng/ml vs 43.17 ±22.27ng/ml, P < 0.01).(2) Correlation between serum NGAL level and severity of coronary artery disease in patients with NSTEMI: Pearson correlation analysis showed that a significant positive correlation between serum NGAL levels and the Grace risk score(r = 0.50, P < 0.01),SYNTAX score(r = 0.54, P < 0.01) and Gensini score(r = 0.56, P < 0.01) NSTEMI patients had. The NSTEMI group divided into two groups according to the SYNTAX score,(SYNTAX score >22) group and mild lesions(SYNTAX score ≤ 22) group of coronary artery disease. Serum NGAL levels was significantly higher in the moderate to severe lesions group than mild lesion group(143.57 + 47.96ng/ml vs92.79 + 43.44ng/ml, P < 0.01). The NSTEMI group divided into single vessel group,two branch lesion group and three vessel disease group according to the number of lesions vessel, the serum NGAL levels were 56.74 + 15.75ng/ml, 127.10 + 19.13ng/ml and 18.15 + 23.22ng/ml respectively, overall differences between the three groups have statistical significance(F=145.42, P < 0.01) and SNK-q test showed a significant difference between the three groups, with the increase of the number of vascular diseases, the level of serum NGAL in NSTEMI patients was significantly increased.(3) Univariate and Multivariate logistic regression analysis : Univariate and Multivariate logistic regression analysis show that serum NGAL level and hs-CRP in independent risk factors for moderate to severe lesions(SYNTAX score >22) of coronary artery in NSTEMI patients(P < 0.05).(4) Analysis of serum NGAL levels to predict moderate to severe lesions(SYNTAX score >22) of coronary artery in NSTEMI patients: ROC curve analysis showed that the optimal cutoff value for serum NGAL levels predict moderate to severe lesions was110ng/ml, Area under the curve was 0.78, the sensitivity was 78.57% and the specificity was 66.67%( P < 0.01).(5) Analysis of the correlation between serum NGAL level and short-term prognosis in patients with NSTEMI : the NSTEMI group were follow-up for 6 months, results showed that a total of 14(29.79%) patiens readmission and occurrence of cardiovascular adverse events,the readmission of 9(19.15%)cases and the occurrence of adverse cardiovascular events in 5(10.64%)cases. ROC curve analysis showed that the optimal cut-off value of serum NGAL level to predict readmission and cardiovascular events for NSTEMI patients was 140ng/ml, the specificity was84.85%and the sensitivity was 64.29%, the area under the curve of 0.81. The NSTEMI group divided into two groups according to optimal cut-off value of serum NGAL level(140ng/ml). x2 test results showed that NGAL equal or higher than 140ng/ml was6.69 times possibility to develop recurrent angina readmission and adverse cardiovascular events(95%CI:1.69~26.45, P < 0.01).There is significantly difference in survival curves between the two groups(logrank test value: 8.92, P < 0.01).Conclusions:1. Serum NGAL level was positively correlated with the severity and complexity of coronary artery disease in patients with NSTEMI;2.Serum NGAL level may benefit to the assessment of the risk of clinical and coronary angiographic outcomes in patients with NSTEMI;3.Serum NGAL is an independent risk factor for predicting the severity lesions of coronary artery in patients with NSTEMI;4.Serum NGAL has an auxiliary value in the evaluation of short-term prognosis of NSTEMI patients.