Copyright © 2001 by the European Society of Cardiology.
Prognostic value of serum gamma-glutamyl transferase activity after myocardial infarction
a CNR Institute of Clinical Physiology, National Research Council, Pisa, Italy
b Department of Experimental Pathology, University of Pisa, Pisa, Italy
revised May 15, 2001; accepted June 1, 2001
Abstract
Aims Serum gamma-glutamyl transferase activity (
-GT) is able to catalyse low-density lipoprotein oxidation and has been detected in coronary atherosclerotic plaques. -GT has been documented as an independent risk factor for cardiac mortality in middle-aged men. The purpose of this study is to determine the prognostic value of -GT in patients with coronary artery disease.
Methods and Results In a prospective study, -GT and other cardiac risk factors were evaluated in 469 consecutive subjects with angiographically documented coronary artery disease, using mortality and mortality plus non-fatal myocardial infarction as end-points. -GT showed an independent prognostic value beyond known established risk factors in the subgroup of 262 patients with previous myocardial infarction. At a 6-year follow-up, cardiac mortality was 25·2% in patients with -GT >40U.l–1vs 13·9% in those with -GT <40U.l–1(P=0·038). When both cardiac mortality and non-fatal myocardial infarction were considered as end-points, these events were recorded in 32·7% of patients with -GT >40U.l–1and in 20·4% of those with levels <40U.l–1(P=0·031). Excess mortality and non-fatal infarction in patients with high -GT levels were concentrated in the first 2 years of follow-up (P=0·014). The association of -GT values >40U.l–1, previous myocardial infarction, and multiple vessel disease identified a subgroup of 168 patients with the highest risk of cardiac events at 6 years (P=0·024). The relationship between -GT levels and cardiac events remained significant after adjustment for cardiac risk factors, and possible confounders, including alcohol consumption. -GT did not show significant prognostic value in the 207 patients without previous myocardial infarction.
Conclusion-GT is an independent cardiac risk factor in ischaemic patients with established coronary atherosclerosis and previous myocardial infarction.
Key Words: -GT activity, cardiac mortality, myocardial infarction, coronary atherosclerosis
f1 Correspondence: Michele Emdin, CNR Institute of Clinical Physiology, National Research Council, Via G. Moruzzi 1, 56100, Pisa, Italy.
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