title: 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.
abstract: OBJECTIVE
  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).
  
  
  METHODS
  Prospective observational cohort study.
  
  
  METHODS
  One university/tertiary centre.
  
  
  METHODS
  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.
  
  
  RESULTS
  
  
  
  METHODS
  1-year mortality.
  
  
  RESULTS
  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.
  
  
  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.
authors.affiliation: Department of Cardiology, University Hospital Brno, Brno, Czech Republic Medical Faculty, Masaryk University, Brno, Czech Republic.
authors.forename: Katerina
authors.initials: K
authors.lastname: Helanova
authors.affiliation: Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic.
authors.forename: Simona
authors.initials: S
authors.lastname: Littnerova
authors.affiliation: Department of Cardiology, University Hospital Brno, Brno, Czech Republic Medical Faculty, Masaryk University, Brno, Czech Republic.
authors.forename: Petr
authors.initials: P
authors.lastname: Kubena
authors.affiliation: Department of Cardiology, University Hospital Brno, Brno, Czech Republic Medical Faculty, Masaryk University, Brno, Czech Republic.
authors.forename: Eva
authors.initials: E
authors.lastname: Ganovska
authors.affiliation: Department of Cardiology, University Hospital Brno, Brno, Czech Republic Medical Faculty, Masaryk University, Brno, Czech Republic.
authors.forename: Marie
authors.initials: M
authors.lastname: Pavlusova
authors.affiliation: Department of Cardiology, University Hospital Brno, Brno, Czech Republic Medical Faculty, Masaryk University, Brno, Czech Republic.
authors.forename: Lenka
authors.initials: L
authors.lastname: Kubkova
authors.affiliation: Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic.
authors.forename: Jiri
authors.initials: J
authors.lastname: Jarkovsky
authors.affiliation: Faculty of Medicine, Institute of Pathological Physiology, Masaryk University, Brno, Czech Republic.
authors.forename: Monika
authors.initials: M
authors.lastname: Pavkova Goldbergova
authors.affiliation: Faculty of Medicine, Institute of Pathological Physiology, Masaryk University, Brno, Czech Republic.
authors.forename: Jolana
authors.initials: J
authors.lastname: Lipkova
authors.affiliation: Department of Biochemistry, University Hospital Brno, Brno, Czech Republic Faculty of Medicine, Department of Laboratory Methods, Masaryk University, Brno, Czech Republic.
authors.forename: Jana
authors.initials: J
authors.lastname: Gottwaldova
authors.affiliation: Department of Cardiology, University Hospital Brno, Brno, Czech Republic Medical Faculty, Masaryk University, Brno, Czech Republic.
authors.forename: Petr
authors.initials: P
authors.lastname: Kala
authors.affiliation: Department of Cardiology, University Hospital Brno, Brno, Czech Republic Medical Faculty, Masaryk University, Brno, Czech Republic Department of Cardiovascular Disease, International Clinical Research Center -University Hospital St Anne's, Brno, Czech Republic.
authors.forename: Ondrej
authors.initials: O
authors.lastname: Toman
authors.affiliation: Department of Biochemistry, University Hospital Brno, Brno, Czech Republic Faculty of Medicine, Department of Laboratory Methods, Masaryk University, Brno, Czech Republic.
authors.forename: Milan
authors.initials: M
authors.lastname: Dastych
authors.affiliation: Department of Cardiology, University Hospital Brno, Brno, Czech Republic Medical Faculty, Masaryk University, Brno, Czech Republic Department of Cardiovascular Disease, International Clinical Research Center -University Hospital St Anne's, Brno, Czech Republic.
authors.forename: Jindrich
authors.initials: J
authors.lastname: Spinar
authors.affiliation: Department of Cardiology, University Hospital Brno, Brno, Czech Republic Medical Faculty, Masaryk University, Brno, Czech Republic Department of Cardiovascular Disease, International Clinical Research Center -University Hospital St Anne's, Brno, Czech Republic.
authors.forename: Jiri
authors.initials: J
authors.lastname: Parenica
mesh_terms: D000209:Acute-Phase Proteins; D015415:Biomarkers / Q000097:blood; D018153:Czech Republic / Q000453:epidemiology; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D000071068:Lipocalin-2; D054834:Lipocalins / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000175:diagnosis / Q000401:mortality; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D062645:Percutaneous Coronary Intervention; D011184:Postoperative Period; D011379:Prognosis; D011446:Prospective Studies; D011518:Proto-Oncogene Proteins / Q000097:blood*; D012372:ROC Curve; D015996:Survival Rate / Q000639:trends
chemical_list: D000209:Acute-Phase Proteins; D015415:Biomarkers; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D011518:Proto-Oncogene Proteins; D020097:Natriuretic Peptide, Brain