Elevated Neutrophil Gelatinase-Associated Lipocalin for the Assessment of Structural versus Functional Renal Damage among ST-Segment Elevation Myocardial Infarction Patients

Background: Neutrophil gelatinase-associated lipocalin (NGAL) is an early marker of renal tubular damage. We investigated the incidence and possible implications of elevated NGAL levels (suggesting renal damage) compared to both functional and damage markers (manifested as serum creatinine [sCr] elevation) and no NGAL/sCr change, among ST-elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (PCI). Methods: We included 131 patients with STEMI treated with PCI. Blood samples for plasma NGAL were drawn 24 h following PCI. We used the terms NGAL(–) or NGAL(+) with levels ≥100 ng/mL suggesting renal tubular damage and the terms. sCr(–) or sCr(+) to consensus diagnostic increases in sCr defining acute kidney injury. Patients were also assessed for in hospital-adverse outcomes. Results: Of the study patients, 56 (42%) were NGAL(–)/sCr(–), 58 (44%) NGAL(+)/sCr(–), and 18 (14%) were both NGAL(+)/sCr(+). According to the 3 study groups, there was a stepwise increase in the proportion of left ventricular ejection fraction ≤45% (43 vs. 60. vs. 72%; p = 0.04), in-hospital adverse outcomes (9 vs. 14 vs. 56%; p < 0.001) and their combination. Specifically, more NGAL(+)/sCr(–) patients developed the composite endpoint when compared to NGAL(–)/sCr(–) patients (64 vs. 46%; OR 2.1, [95% CI 1.1–4.5], p = 0.05). A similar and consistent increase was observed in peak sCr, length of hospital stay, and C-reactive protein levels. Conclusions: Elevated NGAL levels suggesting renal tubular damage, increased inflammation, or both are common among STEMI patients and are associated with adverse outcomes even in the absence of diagnostic increase in sCr.

Download Full-text

Detection of Renal Injury Following Primary Coronary Intervention among ST-Segment Elevation Myocardial Infarction Patients: Doubling the Incidence Using Neutrophil Gelatinase-Associated Lipocalin as a Renal Biomarker

Journal of Clinical Medicine ◽

10.3390/jcm10102120 ◽

2021 ◽

Vol 10 (10) ◽

pp. 2120

Author(s):

Lior Lupu ◽

Keren-Lee Rozenfeld ◽

David Zahler ◽

Samuel Morgan ◽

Ilan Merdler ◽

...

Keyword(s):

Myocardial Infarction ◽

Coronary Intervention ◽

Left Ventricular ◽

Adverse Outcomes ◽

Left Ventricular Ejection ◽

Tubular Damage ◽

Ventricular Ejection Fraction ◽

St Segment Elevation ◽

Neutrophil Gelatinase Associated Lipocalin ◽

Neutrophil Gelatinase

Background: A subgroup of patients with acute kidney injury (AKI) do not fulfil the functional criteria for AKI diagnosis but show elevated levels of new biomarkers reflecting tubular injury, suggesting that these patients suffer “subclinical AKI”. We investigated the incidence and possible implications of “subclinical AKI”, compared to no and clinical AKI among ST elevation myocardial infarction patients (STEMI) treated with primary coronary intervention (PCI). Methods: We included 223 patients with STEMI treated with PCI. Neutrophil gelatinase-associated lipocalin (NGAL) was used as a marker of renal tubular damage in the absence of functional AKI, with NGAL levels ≥100 ng/mL suggesting subclinical AKI. Patients were assessed for the occurrence of in-hospital adverse outcomes. Results: Of the study patients, 45 (25%) had subclinical AKI. These patients were more likely to have left ventricular ejection fraction ≤45% (33% vs. 23%. p = 0.01), in-hospital adverse outcomes (73% vs. 48%; p = 0.005), and a combination of the two. The multivariate regression model demonstrated that subclinical AKI was independently associated with in-hospital adverse outcomes (OR 3.71, 95% CI 1.30–10.62, p = 0.02). Conclusions: Subclinical AKI is common among STEMI patients and is independently associated with adverse outcomes, even in the absence of functional AKI.

Download Full-text

Neutrophil Gelatinase-Associated Lipocalin for the Assessment of Reversible versus Persistent Renal Tubular Damage in ST-Segment Myocardial Infarction Patients

Blood Purification ◽

10.1159/000513943 ◽

2021 ◽

Vol 50 (6) ◽

pp. 925-930

Author(s):

Ariel Banai ◽

Keren-Lee Rozenfeld ◽

Itamar Loewenstein ◽

David Zahler ◽

Moshe Shtark ◽

...

Keyword(s):

Myocardial Infarction ◽

Kidney Injury ◽

Coronary Intervention ◽

Tubular Damage ◽

Symptom Duration ◽

Tubular Injury ◽

Renal Tubular Damage ◽

Neutrophil Gelatinase Associated Lipocalin ◽

Renal Tubular ◽

Neutrophil Gelatinase

Background: Most studies investigated the value of neutrophil gelatinase-associated lipocalin (NGAL) as a marker of renal tubular injury only at a single time point. We investigated the possible utilization of NGAL level dynamics for the identification of different renal injury patterns in ST-elevation myocardial infarction (STEMI) patients. Methods: Blood samples for plasma NGAL in 132 STEMI patients were drawn immediately before and 24 h following primary coronary intervention. Abnormal elevation of NGAL levels was defined using the cardiac surgery-associated NGAL score with NGAL levels ≥100 ng/mL suggesting renal tubular damage. According to NGAL levels at 0 and 24 h, patients were stratified into 3 groups: no tubular damage (NGAL <100 ng/mL in both exams), reversible tubular damage (NGAL >100 ng/mL at 0 h but <100 ng/mL at 24 h), and persistent tubular damage (NGAL >100 ng/mL at both 0 and 24 h). Results: Mean age was 62 ± 13 years, and 78% were men. Of these patients, 29/132 (22%) demonstrated reversible tubular damage, and 36/132 (27%) persistent tubular damage. Only 13/132 patients (10%) progressed to clinical acute kidney injury during hospitalization, all of whom had persistent tubular injury. In multivariate regression model, symptom duration was independently associated with persistent tubular damage, both as continues variable (odds ratio [OR] 1.02, 95% confidence interval [CI] 1.01–1.04; p = 0.04) and for symptom duration >360 min (OR 2.66, 95% CI 1.07–6.63; p = 0.03). Conclusions: Renal tubular damage is common among STEMI patients. Dynamic NGAL measurement may differentiate between reversible and persistent tubular damage. Further trials are needed in order to assess the complex cardiorenal interactions.

Download Full-text

Neutrophil Gelatinase-Associated Lipocalin (NGAL) measured at admission is associated with development of late cardiogenic shock and mortality in patients with STEMI

European Heart Journal Acute Cardiovascular Care ◽

10.1093/ehjacc/zuab020.169 ◽

2021 ◽

Vol 10 (Supplement_1) ◽

Author(s):

M Frydland ◽

R Moegelvang ◽

JE Moeller ◽

O Moeller-Helgestad ◽

L Holmvang ◽

...

Keyword(s):

Myocardial Infarction ◽

Plasma Concentration ◽

Cardiogenic Shock ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Kidney Dysfunction ◽

Neutrophil Gelatinase Associated Lipocalin ◽

Plasma Ngal ◽

All Cause Mortality ◽

Neutrophil Gelatinase

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Rigshospitalets Forskningsfond (Grant number: 07IO) Hjerteforeningen (Grant number A6024) Lundbeckfonden (Grant number R186-2015-2132) BACKGROUND In patients with ST-elevation myocardial infarction (STEMI) increased inflammatory response is associated with development of cardiogenic shock (CS). Neutrophil Gelatinase-Associated Lipocalin (NGAL) is a glycoprotein released from mature neutrophils and the plasma concentration of NGAL likely increases immediately after STEMI. PURPOSE We aimed to assess whether admission NGAL plasma concentration in patients with STEMI was associated with CS development after leaving the catheterization laboratory (late CS) and 30-day all-cause mortality. MATERIALS AND METHODS From 1892 consecutive patients with STEMI 1626 (86%) had plasma NGAL concentration measured upon hospital admission before angiography throughout a 1-year period at two tertiary heart centers in Denmark. Patients were stratified according to NGAL quartiles (Q1-4). To assess late CS development, we adjusted for the Observatoire Régional Breton sur l’Infarctus (ORBI) risk score for late CS. For mortality assessment, we adjusted for gender, age, post-PCI culprit Thrombolysis in myocardial infarction (TIMI) flow, left ventricular ejection fraction (LVEF), kidney dysfunction, admission lactate concentration and being comatose after cardiac arrest. RESULTS Increasing NGAL concentration was associated with higher age, more comorbidities (hypertension, diabetes, heart failure, previous stroke, and kidney dysfunction) and more critical patient conditions at presentation including lower blood pressure and LVEF. Plasma NGAL concentration was associated with both late CS development and 30-day mortality (Figure). When adjusted for factors associated with poor outcome, NGAL remained independently associated with both late CS development (Q4 vs. Q1-3) (OR (95% CI) 2.64 (1.57-6.03)) and 30-day mortality (HR (95% CI) 3.18 (1.46-6.93)). CONCLUSION High admission plasma concentration of NGAL in patients with STEMI was independently associated late CS development and 30-day all-cause mortality. Abstract Figure. NGAL quartiles and late CS/mortality

Download Full-text

Neutrophil Gelatinase-Associated Lipocalin for the Early Prediction of Acute Kidney Injury in ST-Segment Elevation Myocardial Infarction Patients Treated with Primary Percutaneous Coronary Intervention

Cardiorenal Medicine ◽

10.1159/000506378 ◽

2020 ◽

Vol 10 (3) ◽

pp. 154-161

Author(s):

Ilan Merdler ◽

Keren-Lee Rozenfeld ◽

David Zahler ◽

Moshe Shtark ◽

Ilana Goldiner ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Kidney Injury ◽

Sensitivity And Specificity ◽

Kidney Injury ◽

Coronary Intervention ◽

Tubular Damage ◽

Neutrophil Gelatinase Associated Lipocalin ◽

Plasma Ngal ◽

Renal Tubular ◽

Neutrophil Gelatinase

Introduction and Objective: Neutrophil gelatinase-associated lipocalin (NGAL), a glycoprotein released by renal tubular cells, can be used as a marker of early tubular damage. We evaluated plasma NGAL level utilization for the identification of acute kidney injury (AKI) among ST-elevation myocardial infarction (STEMI) patients undergoing primary coronary intervention (PCI). Methods: 131 STEMI patients treated with PCI were prospectively included. Plasma NGAL levels were drawn prior to PCI (0 h) and 24 h afterwards. AKI was defined per KDIGO criteria of serum creatinine increase. Receiver-operating characteristic (ROC) methods were used to identify optimal sensitivity and specificity for the observed NGAL range. Results: Overall AKI incidence was 14%. NGAL levels were significantly higher for patients with AKI at both 0 h (164 ± 42 vs. 95 ± 30; p < 0.001) and 24 h (142 ± 41 vs. 93 ± 36; p < 0.001). Per ROC curve analysis, an optimal cutoff value of NGAL (>120 ng/mL) predicted AKI with 80% sensitivity and specificity (AUC 0.881, 95%, CI 0.801–0.961, p < 0.001). In a multivariate logistic regression model, NGAL levels were independently associated with AKI at 0 h (OR 1.044, 95% CI 1.013–1.076; p = 0.005) and 24 h (OR 1.018, 95% CI 1.001–1.036; p = 0.04). Conclusions: Elevated NGAL levels, suggesting renal tubular damage, are independently associated with AKI in STEMI patients undergoing primary PCI.

Download Full-text

Tactical approaxhes to diagnosis and treatment of hepatorenal syndrome in patients with blastomatous obstructive jaundice

Problems of Uninterrupted Medical Training and Science ◽

10.31071/promedosvity2021.02.028 ◽

2021 ◽

Vol 42 (2) ◽

pp. 28-31

Author(s):

S. V. Kosulin ◽

◽

Ju. O. Vinnik ◽

Ju. V. Ivanova ◽

◽

...

Keyword(s):

Obstructive Jaundice ◽

Hepatorenal Syndrome ◽

Resistance Index ◽

Doppler Imaging ◽

Coagulation System ◽

Tubular Damage ◽

Renal Tubular Damage ◽

Renal Tubular ◽

Neutrophil Gelatinase

The article discusses problems of early diagnosis and, accordingly, treatment of hepatorenal syndrome (HRS) in case of obstructive jaundice of blastomatous origin. The results of a comprehensive examination of 37 patients with blastomatous obstructive jaundice (OJ) with clinical and laboratory signs of HRS were analyzed. Patients were evaluated for clinical and biochemical parameters of blood and urine, blood electrolytes, indicators of the blood coagulation system according to unified methods. The main work is devoted to the determination of the biomarker of renal tubular damage, neutrophil-gelatinase-associated lipocaine (s-NGAL) as a marker and indicator of HRS severity, careful and detailed analysis, monitoring of levels (s-NGAL) and other bioactive substances as an indicator of treatment efficacy. Introduction of active ultrasound as a replacement for contrast computer tomography to reduce the load on precompromised kidneys. It has been proven that the level of renal tubular damage, neutrophil-gelatinase-associated lipocaine s-NGAL is an early marker of renal damage whose function is to reduce the severity of damage to the proximal tubules of the kidneys, normalize damaged tissue by participating in apoptosis, increase survival of damaged restoration of damaged epithelium, stimulation of differentiation and structural reorganization of renal epithelial cells. The fact that s-NGAL was not significantly reduced in the stage of recovery of diuresis, confirms the presence of patients with blastomatous MF severe and persistent toxic tubulointerstitial disorders. Based on this determination of the biomarker (s-NGAL) in the serum of patients with blastomatous mechanical jaundice and performing in them at primary ultrasound color Doppler mapping and pulsed wave Doppler imaging of the kidneys with the calculation of the resistance index may serve as early signs of damage.

Download Full-text

Abstract 14103: Lipoprotein (a) is an Important Factor to Determine Myocardial Viability and Left Ventricular Functional Recovery After Acute Myocardial Infarction

Circulation ◽

10.1161/circ.132.suppl_3.14103 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Kazuto Hayasaka ◽

Hiroyuki Hikita ◽

Takatoshi Shigeta ◽

Toru Misawa ◽

Takafumi Mizusawa ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Myocardial Viability ◽

Left Ventricular ◽

High Serum ◽

Adverse Outcomes ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Lipoprotein A

Introduction: High serum levels of lipoprotein (a) (Lp(a)) are associated with adverse outcomes after acute myocardial infarction (AMI). Lp(a) exerts its atherogenic and thrombogenic properties, which suggests greater lipid component of plaque and thrombi at the culprit lesion of AMI with elevated Lp(a). The risk of coronary artery disease is increased with a threshold serum Lp(a) level of 25 mg/dl. Purpose: We sought to evaluate impact of Lp(a) on myocardial viability and left ventricular function after AMI. Methods: The study included 156 patients (66±10.7 yrs, mean±sd, men 122, LAD/LCX/RCA 80/16/60) with first AMI within 24 hours from the onset who underwent emergent PCI. Serum Lp(a) was measured at admission. Serum CPK values were measured at admission and at intervals of 4 hours. Peak CPK value was determined. Within 2 weeks, Tl/BMIPP SPECT was performed to measure perfusion-metabolism mismatch score, an indicator of viable myocardium, from each total defect score of Tl/BMIPP using 17-segment model and semiquantitative visual score (0:normal, to 4:no uptake). Left ventricular ejection fraction (LVEF) was measured by two-dimensional echocardiography (2D trace) within 1 week (baseline LVEF) and at 6 months to 1 year (follow-up LVEF). Results: The study patients were divided into the group with serum Lp(a)≧25mg/dl at admission (n=42, Lp(a) 44.0±19.4mg/dl) and the group with Lp(a)<25 (n=114, Lp(a) 10.8±6.5). There were no significant differences between the two groups with respect to age, gender, peak CPK (2732±2060 IU/L (Lp(a)≧25), 2971±2254 (Lp(a)<25)). The mismatch score was significantly lower in Lp(a)≧25 group than in Lp(a)<25 (4.4±3.3 vs 5.9±3.9, p<0.05, respectively). Δ%LVEF (100*(follow-up LVEF - baseline LVEF)/ baseline LVEF) was significantly lower in Lp(a)≧25 than Lp(a)<25 (-2.0±11.0 vs 7.4±13.0, p<0.05, respectively). Conclusions: Elevated Lp(a) was associated with less myocardial viability and less LVEF recovery after AMI.

Download Full-text

P0829THE ASSOCIATION BETWEEN URINARY NGAL AND EGFR SLOPE IN PATIENTS WITH CKD

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p0829 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Shungo Fukuda ◽

Naohiko Fujii ◽

Taisuke Matsushita ◽

Sayoko Yonemoto ◽

Daisuke Hayashi ◽

...

Keyword(s):

Tubular Damage ◽

Clinical Value ◽

Loss To Follow Up ◽

Neutrophil Gelatinase Associated Lipocalin ◽

Lower Egfr ◽

Exposure Variable ◽

Renal Tubular ◽

Neutrophil Gelatinase ◽

Egfr Decline

Abstract Background and Aims Urinary neutrophil gelatinase-associated lipocalin (uNGAL) is a new biomarker for renal tubular damage. The association between uNGAL and renal prognosis have been reported in many papers; however, it may often be affected by urinary tract infection (UTI), and its clinical value with consideration of UTI has not been well investigated in patients with chronic kidney disease (CKD). The aims of our study were to investigate the association between uNGAL and eGFR decline in CKD incorporating the effect of UTI. Method This was a retrospective observational cohort study at a single hospital in Japan. We included adult patients with the estimated glomerular filtration rate (eGFR) of 10 to 70 mL/min/1.73m2 from Jan 2017, who had at least one measurement of uNGAL. We used baseline uNGAL adjusted for urinary creatinine (Cr) as an exposure variable and divided the patients into quartiles. UTI was determined by a single evaluation of urinalysis at baseline. The repeated measured eGFRs were obtained from the electrical health record until dialysis initiation, loss to follow-up, or the end of the observation period whichever occurred first. We performed longitudinal analyses for eGFR decline using the mixed effects model and evaluated the longitudinal effect of uNGAL taking into account of UTI. All statistical analyses were done using STATA 13.1. Results In total, 281 patients with CKD were included. Mean age and eGFR at baseline were 70.2 years and 33.9 mL/min/1.73m2, respectively. The median [interquartile range (IQR)] of baseline uNGAL and urinary protein to Cr ratio (uPCR) were 49.6 [19.4 - 171.4] ug/gCr and 0.82 [0.18 - 3.26] g/gCr, respectively. Patients with UTI (15%) showed significantly higher uNGAL at baseline than those without (219 [89 - 425] vs. 39 [16 - 131]). During the mean follow up of 229 days, nine patients developed eGFR < 5 mL/min/1.73m2. Although a higher uNGAL level was significantly associated with lower eGFR levels at baseline (-3.3 [95% confidence interval (CI): -7.6, 0.93], -9.6 [-14.2, -4.9], and -16.3 [-21.4, -11.1] mL/min/1.73m2 in quartiles Q2-4 as compared to Q1); the eGFR trajectory did not differ with or without baseline UTI in the analytic model, while baseline proteinuria was significantly associated with a steeper slope of eGFR. Conclusion A higher uNGAL was significantly associated with lower eGFR levels at baseline; however, it was not associated with a steeper slope of eGFR in the longitudinal analysis, even with the consideration of the effect of UTI.

Download Full-text

Prognostic value of neutrophil gelatinase-associated lipocalin and cystatin C in patients with heart failure and previous myocardial infarction

Russian Journal of Cardiology ◽

10.15829/1560-4071-2021-4126 ◽

2021 ◽

Vol 26 (1) ◽

pp. 4126

Author(s):

N. V. Kompanets ◽

Yu. V. Shchukin ◽

L. V. Limareva ◽

M. V. Komarova

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Adverse Events ◽

Cystatin C ◽

Prognostic Value ◽

Left Ventricular ◽

Syntax Score ◽

Neutrophil Gelatinase Associated Lipocalin ◽

Patients With Heart Failure ◽

Neutrophil Gelatinase

Aim. To study the prognostic value of neutrophil gelatinase-associated lipocalin (NGAL or lipocalin-2) and cystatin C in patients with heart failure (HF) and myocardial infarction (MI).Material and methods. Baseline plasma concentrations of NGAL and cystatin C were measured in 119 participants (median age, 50-61 years; men, 101) with HF and primary MI (4-6 weeks old) who underwent percutaneous coronary intervention in the acute period. Adverse cardiovascular events within 1 year were considered as the endpoint.Results. Patients with elevated NGAL levels were significantly more likely to have adverse events (p<0,001). The optimal cut-off value for NGAL was 18,75 ng/ml (odds ratio, 10, 95% CI, 3,09-32,45; p=0,0001). Multivariate logistic regression showed that NGAL, N-terminal pro-brain natriuretic peptide, left ventricular aneurysm, and SYNTAX score were significant predictors of adverse events. Cystatin C did not affect prognosis in the study cohort.Conclusion. Increased NGAL levels is a predictor of unfavorable clinical outcome in patients with HF and previous MI.

Download Full-text

Acute kidney injury and renal tubular damage in children with type 1 diabetes mellitus onset

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgab090 ◽

2021 ◽

Author(s):

Pierluigi Marzuillo ◽

Dario Iafusco ◽

Angela Zanfardino ◽

Stefano Guarino ◽

Alessia Piscopo ◽

...

Keyword(s):

Acute Kidney Injury ◽

Biochemical Parameters ◽

Kidney Injury ◽

Fractional Excretion ◽

Tubular Damage ◽

Renal Tubular Damage ◽

Neutrophil Gelatinase Associated Lipocalin ◽

Renal Tubular ◽

Beta 2 Microglobulin ◽

Physiological And Biochemical

Abstract Context Acute kidney injury(AKI) and renal tubular damage(RTD), especially if complicated by acute tubular necrosis (ATN), could increase the risk of later chronic kidney disease. No prospective studies on AKI and RTD in children with type1diabetes mellitus(T1DM) onset are available. Objectives to evaluate the AKI and RTD prevalence, and their rate and timing of recovery in children with T1DM onset. Design prospective study. Settings and patients: 185children were followed up after 14days from T1DM onset. The patients who did not recover from AKI/RTD were followed-up 30 and 60days later. Main outcome measures AKI was defined according to the KDIGO criteria. RTD was defined by abnormal urinary beta-2-microglobulin and/or neutrophil gelatinase-associated lipocalin and/or tubular reabsorption of phosphate<85% and/or fractional excretion of Na(FENa)>2%. ATN was defined by RTD+AKI, prerenal-(P-)AKI by AKI+FENa<1% while acute tubular damage(ATD) by RTD without AKI. Results Prevalence of diabetic ketoacidosis(DKA) and AKI were 51.4% and 43.8% respectively. Prevalence of AKI in T1DM patients with and without DKA was 65.2% and 21.1%. 33.3% reached AKI stage2 and 66.7% of patients reached AKI stage1. RTD was evident in 136/185(73.5%) patients (32.4% showed ATN; 11.4% P-AKI; 29.7% ATD). All patients with DKA or AKI presented with RTD. The physiological and biochemical parameters of AKI and RTD were normal again in all patients. The former within 14days and the latter within 2months, respectively. Conclusions Most patients with T1DM onset may develop AKI and/or RTD, especially if presenting with DKA. Over time the physiological and biochemical parameters of AKI/RTD normalize in all patients.

Download Full-text

The Impact of Age on Clinical Outcomes of Coronary Artery Bypass Grafting: Long-Term Results of a Real-World Registry

BioMed Research International ◽

10.1155/2017/9829487 ◽

2017 ◽

Vol 2017 ◽

pp. 1-11 ◽

Cited By ~ 6

Author(s):

Francesco Nicolini ◽

Daniela Fortuna ◽

Giovanni Andrea Contini ◽

Davide Pacini ◽

Davide Gabbieri ◽

...

Keyword(s):

Myocardial Infarction ◽

Older Patients ◽

Left Ventricular ◽

Adverse Outcomes ◽

Long Term Results ◽

Left Ventricular Ejection ◽

Term Survival ◽

Ventricular Ejection Fraction ◽

The Impact

The aim of this retrospective multicenter registry study was to investigate age-dependent trends in mortality, long-term survival, and comorbidity over time in patients who underwent isolated CABG from 2003 to 2015. The percentage of patients < 60 years of age was 18.9%. Female sex, chronic pulmonary disease, extracardiac arteriopathy, and neurologic dysfunction disease were significantly less frequent in this younger population. The prevalence of BMI ≥ 30, previous myocardial infarction, preoperative severe depressed left ventricular ejection fraction, and history of previous PCI were significantly higher in this population. After PS matching, at 5 years, patients < 60 years of age reported significantly lower overall mortality (p<0.0001), cardiac-related mortality (p<0.0001), incidence of acute myocardial infarction (p=0.01), and stroke rates (p<0.0001). Patients < 60 years required repeated revascularization more frequently than older patients (p=0.05). Patients < 60 who underwent CABG had a lower risk of adverse outcomes than older patients. Patients < 60 have a different clinical pattern of presentation of CAD in comparison with more elderly patients. These issues require focused attention in order to design and improve preventive strategies aiming to reduce the impact of specific cardiovascular risk factors for younger patients, such as diet, lifestyle, and weight control.

Download Full-text