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The prognostic role of gamma-glutamyltransferase activity in non-diabetic ST-elevation myocardial infarction

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Abstract

In patients with acute coronary syndrome, gamma-glutamyltransferase activity (GGT) proved to be an independent predictor of the development of major adverse cardiac events at early and long terms. No data are available on GGT in ST-elevation myocardial infarction (STEMI). We assessed, in 337 consecutive STEMI patients without previously known diabetes submitted to mechanical revascularization, the prognostic role of GGT for in-Intensive Cardiac Care Unit mortality, together with the relation(s) between GGT and acute glucose dysmetabolism (admission glycemia, peak glycemia, insulin resistance as indicated by the Homeostatic Model Assessment HOMA index). At logistic regression analysis, GGT was an independent predictor for in-ICU mortality (OR 1.01 (95% CI 1.003–1.013) p = 0.002), when adjusted for BMI and for major bleedings [(OR 1.005 (95% CI 1.001–1.009) p = 0.029]. At linear regression analyses, GGT was significantly correlated with admission glycemia (r = 0.172; p = 0.002), uric acid (r = 0.146; p = 0.011), insulin (r = 0.171; p = 0.002) and age (r = −0.129; p = 0.020). We document that in STEMI patients without previously known diabetes submitted to mechanical revascularization, GGT values are an independent predictor of early mortality. The significant correlation between GGT and acute glucose dysmetabolism (as indicated by admission glycemia and insulin-resistance) can account, at least in part, for the prognostic role of GGT.

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References

  1. Rahman I, MacNee W (2000) Oxidative stress and regulation of glutathione in lung inflammation. EurRespir J 16:534–554

    CAS  Google Scholar 

  2. Hochwald SN, Harrison LE, Rose DM, Anderson M, Burt ME (1996) Gamma-glutamyltranspeptidase mediation of tumor glutathione utilization in vivo. J Natl Cancer Inst 88:193–197

    Article  PubMed  CAS  Google Scholar 

  3. Karp DR, Shimooku K, Lipsky PE (2001) Expression of gamma-glutamyltranspeptidase protects ramos B cells from oxidation-induced cell death. J Biol Chem 276:3798–3804

    Article  PubMed  CAS  Google Scholar 

  4. Paolicchi A, Emdin M, Ghliozeni E, Ciancia E, Passino C et al (2004) Atherosclerotic plaques contain gamma-glutamyltranspeptidase activity. Circulation 109:1140

    Article  Google Scholar 

  5. Paolicchi A, Tongiani R, Tonarelli P, Comporti M, Pompella A (1997) Gammaglutamyltranspeptidase-dependent lipid peroxidation in isolated hepatocytes and HepG2 hepatoma cells. Free RadicBiol Med 22:853–860

    Article  CAS  Google Scholar 

  6. Wannamethee G, Ebrahim S, Shaper AG (1995) Gamma-glutamyltransferase: determinants and association with mortality from ischemic heart disease and all causes. Am J Epidemiol 142:699–708

    PubMed  CAS  Google Scholar 

  7. Pompella A, Emdin M, Passino C, Paolicchi A (2004) The significance of serum γ-glutamyltransferase in cardiovascular diseases. Clin Chem Lab Med 42:1085–1091

    Article  PubMed  CAS  Google Scholar 

  8. Lee DH, Silventoinen K, Hu G, Jacobs DR Jr, Jousilahti P et al (2006) Serum gamma-glutamyltransferase predicts non-fatal myocardial infarction and fatal coronary heart disease among 28, 838 middleaged men and women. Eur Heart J 27:2170–2176

    Article  PubMed  CAS  Google Scholar 

  9. Lee DH, Jacobs DR Jr, Gross M, Kiefe CI, Roseman J et al (2003) Gamma-glutamyltransferase is a predictor of incident diabetes and hypertension: the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Clin Chem 49:1358–1366

    Article  PubMed  CAS  Google Scholar 

  10. Meisinger C, Doring A, Schneider A, Lowel H, KORA Study Group (2006) Serum gamma-glutamyltransferase is a predictor of incident coronary events in apparently healthy men from the general population. Atherosclerosis 189:297–302

    Article  PubMed  CAS  Google Scholar 

  11. Ruttmann E, Brant LJ, Concin H, Diem G, Rapp K, Ulmer H (2005) Gammaglutamyltransferase as a risk factor for cardiovascular disease mortality: an epidemiologic investigation in a cohort of 163 944 Austrian adults. Circulation 112:2130–2137

    Article  PubMed  CAS  Google Scholar 

  12. Emdin M, Passino C, Michelassi C, Titta F, L’abbate A, Donato L et al (2001) Prognostic value of serum gamma-glutamyltransferase activity after myocardial infarction. Eur Heart J 22:1802–1807

    Article  PubMed  CAS  Google Scholar 

  13. Wannamethee SG, Lennon L, Shaper AG (2008) The value of gamma-glutamyltransferase in cardiovascular risk prediction in men without diagnosed cardiovascular disease or diabetes. Atherosclerosis 201(1):168–175

    Article  PubMed  CAS  Google Scholar 

  14. Stojakovic T, Scharnagl H, Trauner M, Pieske B, Wellnitz B, Seelhorst U, Schilling D, Winkelmann BR, Boehm BO, März W (2010) Serum gamma-glutamyltransferase and mortality in persons undergoing coronary angiography—The Ludwigshafen Risk and Cardiovascular Health Study. Atherosclerosis 208(2):564–571

    Article  PubMed  CAS  Google Scholar 

  15. Demircan S, Yazici M, Durna K, Kilicaslan F, Demir S, Pinar M, Gulel O (2009) The importance of gamma-glutamyltransferase activity in patients with coronary artery disease. ClinCardiol 32(4):220–225

    Google Scholar 

  16. Ulus T, Yildirir A, Sade LE, Temiz A, Polat E, Bozbaş H, Aydinalp A, Eroğlu S, Ozin B, Müderrisoğlu H (2008) Serum gamma-glutamyltransferase activity: new high risk criteria in acute coronary patients. Coron Artery Dis 19(7):489–495

    Article  PubMed  Google Scholar 

  17. Lee DS, Evans JC, Robins SJ, Wilson PW, Albano I, Fox CS, Wang TJ, Benjamin EJ, D’Agostino RB, Vasan RS (2007) Gamma-glutamyltransferase and metabolic syndrome, cardiovascular disease and mortality risk the Framingham Heart study. ArteriosclerThrombVasc Biol 27(1):127–133

    CAS  Google Scholar 

  18. Van de Werf F, Bax J, Betriu A et al (2008) Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation: the Task Force on the Management of ST-Segment Elevation Acute Myocardial Infarction of the European Society of Cardiology. Eur Heart J 29(23):2909–2945

    Article  PubMed  Google Scholar 

  19. Valente S, Lazzeri C, Chiostri M et al (2009) NT-proBNP on admission for early risk stratification in STEMI patients submitted to PCI. Relation with extension of STEMI and inflammatory markers. Int J Cardiol 132(1):84–89

    Article  PubMed  Google Scholar 

  20. Levey AS, Stevens LA, Schmid CH et al (2009) A new equation to estimate glomerular filtration rate. Ann Intern Med 150(9):604–612

    PubMed  Google Scholar 

  21. Balkau B, Charles M (1999) for the European Group for the Study of Insulin Resistance (EGIR). Comment on the provisional report from the WHO Consultation. Diabet Med 16:442–443

    Article  PubMed  CAS  Google Scholar 

  22. Lazzeri C, Valente S, Chiostri M, Picariello C, MD GensiniGF (2010) Acute glucose dysmetabolism in the early phase of ST-elevation myocardial infarction: the age response. Diab Vasc Dis Res 7(2):131–137

    Article  PubMed  Google Scholar 

  23. Lazzeri C, Sori A, Chiostri M et al (2009) Prognostic role of insulin resistance as assessed by homeostatic model assessment index in the acute phase of myocardial infarction in nondiabetic patients submitted to percutaneous coronary intervention. Eur J Anaesthesiol 26(10):856–862

    Article  PubMed  CAS  Google Scholar 

  24. Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, Gordon DJ, Krauss RM, Savage PJ, Smith SC Jr, Spertus JA, Costa F (2005) Diagnosis and management of the metabolic syndrome. An American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation 112:2735–2752

    Article  PubMed  Google Scholar 

  25. Huang PL (2009) A comprehensive definition for metabolic syndrome. Dis Model Mech 2(5–6):231–237

    Article  PubMed  CAS  Google Scholar 

  26. Ceriello A, Zarich SW, Testa R (2009) Lowering glucose to prevent adverse cardiovascular outcomes in a critical care setting. J Am Coll Cardiol 53:S9–S13

    Article  PubMed  CAS  Google Scholar 

  27. Lazzeri C, Tarquini R, Giunta F, Gensini GF (2009) Glucose dysmetabolism and prognosis in critical illness. Intern Emerg Med 4(2):147–156

    Article  PubMed  Google Scholar 

  28. Deedwania P, Kosiborod M, Barrett E et al, American Heart Association Diabetes Committee of the Council on Nutrition, Physical Activity and Metabolism (2008) Hyperglycemia and acute coronary syndrome: a scientific statement from the American heart association diabetes committee of the council on nutrition, physical activity, and metabolism. Circulation 117(12):1610–1619

    Google Scholar 

  29. Karlson BW, Wiklund O, Hallgren P, Sjölin M, Lindqvist J, Herlitz J (2000) Ten-year mortality amongst patients with a very small or unconfirmed acute myocardial infarction in relation to clinical history, metabolic screening and signs of myocardial ischaemia. J Intern Med 247(4):449–456

    Article  PubMed  CAS  Google Scholar 

  30. Lazzeri C, Valente S, Chiostri M, Picariello C, Gensini GF (2010) In hospital peak glycemia and prognosis in STEMI patients without previously known diabetes. Eur J Cardiovasc Prev Rehabil 17(4):419–423

    Article  PubMed  Google Scholar 

  31. Shin JY, Chang SJ, Shin YG, Seo KS, Chung CH (2009) Elevated serum gamma-glutamyltransferase levels are independently associated with insulin resistance in non-diabetic subjects. Diabetes Res Clin Pract 84(2):152–157 (epub 4 March 2009)

    Article  PubMed  Google Scholar 

  32. Lazzeri C, Valente S, Chiostri M, Sori A, Bernardo P, Gensini GF (2010) Uric acid in the acute phase of ST elevation myocardial infarction submitted to primary PCI: its prognostic role and relation with inflammatory markers a single center experience. Int J Cardiol 138(2):206–209

    Article  PubMed  Google Scholar 

  33. Celik T, Iyisoy A (2009) Uric acid levels for the prediction of prognosis in patients with acute ST elevation myocardial infarction: a new potential biomarker. Int J Cardiol (Epub ahead of print)

  34. Car S, Trkulja V (2009) Higher serum uric acid on admission is associated with higher short-term mortality and poorer long-term survival after myocardial infarction: retrospective prognostic study. Croat Med J 50(6):559–566

    Article  PubMed  CAS  Google Scholar 

  35. Feig DI, Kang DH, Johnson RJ (2008) Uric acid and cardiovascular risk. N Engl J Med 359:1811–1821

    Article  PubMed  CAS  Google Scholar 

  36. Emdin M, Pompella A, Paolicchi A (2005) Gamma-glutamyltransferase, atherosclerosis, and cardiovascular disease: triggering oxidative stress within the plaque. Circulation 112:2078–2080

    Article  PubMed  Google Scholar 

  37. Ulus T, Yildirir A, Demirtas S, Demir O, Sade LE et al (2007) Serum gamma-glutamyltransferase activity: anew marker for stent restenosis? Atherosclerosis 195:348–353

    Article  PubMed  CAS  Google Scholar 

  38. Paolicchi A, Minotti G, Tonarelli P, Tongiani R, De Cesare D et al (1999) Gamma-glutamyltranspeptidase-dependent iron reduction and LDL oxidation—a potential mechanism in atherosclerosis. J Investig Med 47:151–160

    PubMed  CAS  Google Scholar 

  39. Ishizaka N, Ishizaka Y, Toda E, Yamakado M, Koike K, Nagai R (2010) Association between gamma-glutamyltransferase levels and insulin resistance according to alcohol consumption and number of cigarettes smoked. J Atheroscler Thromb 17(5):476–485

    PubMed  CAS  Google Scholar 

  40. Turgut O, Tandogan I, Gurlek A (2009) Association of gamma-glutamyltransferase with cardiovascular risk: a prognostic outlook. Arch Med Res 40(4):318–320

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Intensive Cardiac Coronary Unit, Heart and Vessel Department, Azienda Ospedaliero-Universitaria Careggi, University of Florence, VialeMorgagni 85, 50134, Florence, Italy

    Chiara Lazzeri, Serafina Valente, Marco Chiostri, Claudio Picariello & Gian Franco Gensini

  2. Department of Internal Medicine, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy

    Roberto Tarquini

Authors
  1. Chiara Lazzeri
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  2. Serafina Valente
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  3. Roberto Tarquini
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  4. Marco Chiostri
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  5. Claudio Picariello
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  6. Gian Franco Gensini
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Correspondence to Chiara Lazzeri.

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Lazzeri, C., Valente, S., Tarquini, R. et al. The prognostic role of gamma-glutamyltransferase activity in non-diabetic ST-elevation myocardial infarction. Intern Emerg Med 6, 213–219 (2011). https://doi.org/10.1007/s11739-010-0464-8

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  • DOI: https://doi.org/10.1007/s11739-010-0464-8

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