Correlation Between γ-glutamyltransferase And Death In Patients With Acute Non-ST-Segment Elevation Myocardial Infarction After PCI

Objective:This study is designed to investigate long-term prognostic value of serumγ-glutamyltransferase levels(GGT)with Grace risk scores in patients with acute non-ST-segment elevation myocardial infarction(NSTEMI)undergoing percutaneous coronary intervention(PCI).Methods: This study retrospectively included 656 patients with NSTEMI undergoing PCI at the heart of the First Hospital of Lanzhou University from January 2013 to December 2015.Baseline data and follow-up data were collected.The optimal cut-off value of GGT level was determined according to the receiver operating characteristic curve(ROC).The patients were divided into high GGT level group and low GGT level group according to the cut-off value.The baseline data of the two groups were analyzed and compared.Spearman analysis was used to analyze the correlation factors of GGT level;ROG curve was used to evaluate the predictive value of GGT,Grace score,GGT combined with Grace score for the risk of death after NSTEMI by PCI;the survival curve was drawn by Kaplan-Meier method.The number-rank test was used to analyze the mortality risk model of NSTEMI after PCI after the GGT was unadjusted,adjusted for Grace score,and adjusted for other death-related factors.According to the age,the subgroup analysis was divided into the younger group and the older group.The Cox proportional hazard model was used to establish the serum GGT in the subgroup,the Grace risk score was adjusted,and other death-related factors were adjusted.Patient’s risk of death model.Results: A total of 40 patients(6.1%)died during follow-up,17(4.1%)died in the low GGT group,and 23(9.4%)died in the high GGT group.body mass index,and white blood cell count in the high GGT group Lymphocyte count,triglyceride,alanine aminotransferase,uric acid,N-terminal B-type natriuretic peptide,fibrinogen and Grace were higher than the low group(P<0.05);there was significant difference in gender between the two groups.The percentage of males in the high GGT group was significantly higher than that in the low GGT group(P<0.05);the serum GGT level and age in the Spearman correlation analysis(r=-0.164,p<0.001)and,body mass index(r=0.147,p<0.001),heart rate(r=0.088,p=0.024),aspartate aminotransferase(r=0.201,p<0.001),uric acid(r=0.133),p=0.01),triglyceride(r=0.183,p<0.001),high-density lipoprotein(r=-0.106,p=0.006)showed correlation.The area under the ROC curve of GGT was 0.625(95%Cl: 0.5370.713,P<0.05),and the area under the Roc curve of the Grace score was 0.778(95% Cl:0.6870.868,P<0.05).GGT combined with Grace score The area under the Roc curve was 0.823(95% Cl: 0.7470.898,P < 0.05).Kaplan-Meier survival curve results showed that the cumulative death risk in GGT≥35U/L group was significantly greater than that in GGT<35U/L group,the difference was statistically significant(P<0.05).In the unadjusted Cox proportional hazard model,serum GGT levels were associated with an increased risk of death at 36 months(HR: 1.029,95%:1.0071.051,P < 0.05);in the model adjusted for the Grace score,the risk of death was also significantly increased(HR: 1.034,95%: 1.0131.056,P < 0.05);the risk of death was still increased in the risk model adjusted for other factors(HR: 1.036,95%: 1.0121.06,P < 0.05).In the subgroup analysis,males,body mass index,smoking,cardiac function grade I,white blood cell count,lymphocyte count,albumin,triglyceride,aspartate aminotransferase,and serum GGT levels were lower in the younger group than in the older group.Hypertension,diabetes,three-vessel disease,fasting blood glucose,urea nitrogen,NT-proBNP,and Grace scores were lower than those in the older group(P<0.05).Serum GGT levels and mortality risk were not included in the unadjusted Cox proportional hazard model in the elderly group.Correlation(HR: 1.027,95%:1.0031.051,P=0.026);the risk of death was also significantly increased in the model with Grace score adjusted(HR: 1.028,95%: 1.0041.005,P=0.020),adjusted In the risk model of other factors,the risk of death still increased(HR: 1.041,95%: 1.0151.068,P=0.002);there was no correlation between high serum GGT and mortality risk in the younger age group,and the difference was not statistically significant(P>0.05).Conclusion: Serum GGT levels are associated with long-term mortality risk in patients with NSTEMI undergoing PCI,have a predictive value for long-term mortality risk,Combined Grace scores can significantly increase their predictive value.