Gamma-Glutamyl Transferase-to-Platelet Ratio as a Novel Predictor of Long-Term Adverse Outcomes in Patients after Undergoing Percutaneous Coronary Intervention: A Retrospective Cohort Study

Abstract

Background Gamma-glutamyl transferase (GGT) has been shown to be involved in the pathogenesis of both coronary artery disease (CAD) and liver disease, and it has been reported that the GGT-to-platelet ratio (GPR) is an independent predictor for adverse outcomes from liver fibrosis and hepatic carcinoma. However, the relation between the GPR and adverse outcomes in CAD patients after percutaneous coronary intervention (PCI) has not been investigated. Methods A total of 5,636 patients enrolled in Clinical Outcomes and Risk Factors of Patients with Coronary Heart Disease after PCI, a retrospective cohort study, from January 2008 to December 2016, were divided into two groups according to GPR (GPR < 0.12, n = 2,769 and GPR ≥ 0.12, n = 2,867). The primary outcome was long-term mortality including all-cause mortality (ACM) and cardiac mortality (CM) after PCI. The average follow-up time was 35.9 ± 22.6 months. Results We found that there were significant differences between the two groups in the incidences of ACM (p = 0.011), CM (p = 0.001), major adverse cardiovascular events (MACEs, p < 0.024), major adverse cardiovascular and cerebrovascular events (MACCEs, p = 0.014) and bleeding events (p = 0.003). Multivariate Cox regression analyses showed that GPR was an independent predictor for ACM (hazard ratio [HR]: 1.536 [95% confidence interval [CI]:1.162–2.032], p = 0.003), CM (HR: 1.763 [95% CI: 1.283–2.424], p < 0.001), MACCEs (HR: 1.269 [95% CI: 1.066–1.511], p = 0.007) and MACEs (HR: 1.308 [95% CI: 1.089–1.570], p = 0.004) in stable CAD patients but that it was an independent predictor for only the incidence of bleeding events (HR: 3.104 [95% CI: 1.680–5.736], p < 0.001) in acute coronary syndrome (ACS) patients. Conclusion This study indicates that GPR is an independent and novel predictor of adverse long-term outcomes in CAD patients who underwent PCI.

Gamma‐glutamyl transferase to albumin ratio as a novel predictor of bleeding events and mortality in patients after percutaneous coronary intervention: A retrospective cohort study

“…Figure shows the participant flowchart. Clinical and demographic data collection was performed as previously described …”

“…The detection of GGT has been previously described . Briefly, blood samples were collected after at least 12‐hr of fasting and before coronary angiography.…”

“…Briefly, blood samples were collected after at least 12‐hr of fasting and before coronary angiography. The catalytic activity of GGT in plasma was measured at 37°C with an enzymatic colorimetric assay using standard methods of the central laboratory of the First Affiliated Hospital of Xinjiang Medical University as described previously . Albumin (ALB) is the most abundant protein in plasma, accounting for 55–65% of total serum protein.…”

“…The secondary endpoints were: bleeding events; readmission; target vessel reconstruction (TVR); major adverse cardiac events (MACEs), which were defined as the combination of cardiac death, recurrent myocardial infarction, and target vessel reconstruction; and major adverse cardiac and cerebrovascular events (MACCEs) defined as the MACEs plus stroke . The major bleeding events were defined in accordance with the Bleeding Academic Research Consortium definitions types 2, 3, or 5 after PCI as described previously …”

“…The catalytic activity of GGT in plasma was measured at 37 C with an enzymatic colorimetric assay using standard methods of the central laboratory of the First Affiliated Hospital of Xinjiang Medical University as described previously. 11…”