Download PDF
Thromb Haemost 2019; 119(06): 1021-1030
DOI: 10.1055/s-0039-1681103
Atherosclerosis and Ischaemic Disease
Georg Thieme Verlag KG Stuttgart · New York

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

Ying-Ying Zheng
1   Department of Cardiology, First Affiliated Hospital of Zhengzhou University, Key Laboratory of Cardiac Injury and Repair of Henan Province, Zhengzhou, China
2   Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
,
Ting-Ting Wu
2   Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
,
You Chen
2   Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
,
Xian-Geng Hou
2   Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
,
Yi Yang
2   Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
,
Xiang Ma
2   Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
,
Yi-Tong Ma
2   Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
,
Jin-Ying Zhang
1   Department of Cardiology, First Affiliated Hospital of Zhengzhou University, Key Laboratory of Cardiac Injury and Repair of Henan Province, Zhengzhou, China
,
Xiang Xie
2   Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
› Author Affiliations Funding This research was funded by the National Natural Science Foundation of China (U1603381, 81760043 and 81560070).
Further Information

Publication History

17 December 2018

25 January 2019

Publication Date:
01 March 2019 (online)

Also available at
    Permissions and Reprints

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.

Keywords

gamma-glutamyl transferase-platelet ratio - percutaneous coronary intervention - major adverse cardiovascular events - mortality - major adverse cardiovascular and cerebrovascular events - bleeding - gamma-glutamyl transferase
 

  • References

  • 1 Go AS, Mozaffarian D, Roger VL. , et al; American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Executive summary: heart disease and stroke statistics--2014 update: a report from the American Heart Association. Circulation 2014; 129 (03) 399-410
    CrossrefPubMedSearch in Google Scholar
  • 2 Mozaffarian D, Benjamin EJ, Go AS. , et al; American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics--2015 update: a report from the American Heart Association. Circulation 2015; 131 (04) e29-e322
    PubMedSearch in Google Scholar
  • 3 Christodoulidis G, Vittorio TJ, Fudim M, Lerakis S, Kosmas CE. Inflammation in coronary artery disease. Cardiol Rev 2014; 22 (06) 279-288
    CrossrefPubMedSearch in Google Scholar
  • 4 Heusch G, Libby P, Gersh B. , et al. Cardiovascular remodelling in coronary artery disease and heart failure. Lancet 2014; 383 (9932): 1933-1943
    CrossrefPubMedSearch in Google Scholar
  • 5 Boulanger CM, Loyer X, Rautou PE, Amabile N. Extracellular vesicles in coronary artery disease. Nat Rev Cardiol 2017; 14 (05) 259-272
    CrossrefPubMedSearch in Google Scholar
  • 6 Schiele F, Ecarnot F, Chopard R. Coronary artery disease: risk stratification and patient selection for more aggressive secondary prevention. Eur J Prev Cardiol 2017; 24 (3 suppl): 88-100
    CrossrefPubMedSearch in Google Scholar
  • 7 Gorog DA. Prognostic value of plasma fibrinolysis activation markers in cardiovascular disease. J Am Coll Cardiol 2010; 55 (24) 2701-2709
    CrossrefPubMedSearch in Google Scholar
  • 8 Leone A. Markers of atherosclerotic disease: what do they mean? Current opinion and future trends. Curr Pharm Des 2016; 22 (01) 7-17
    PubMedSearch in Google Scholar
  • 9 Dillon JF, Miller MH. Gamma glutamyl transferase ‘To be or not to be’ a liver function test?. Ann Clin Biochem 2016; 53 (06) 629-631
    CrossrefPubMedSearch in Google Scholar
  • 10 Baiu I, Hawn MT. Gallstones and biliary colic. JAMA 2018; 320 (15) 1612
    CrossrefPubMedSearch in Google Scholar
  • 11 Niemelä O, Niemelä S, Ritvanen A. , et al. Assays of gamma-glutamyl transferase and carbohydrate-deficient transferrin combination from maternal serum improve the detection of prenatal alcohol exposure. Alcohol Clin Exp Res 2016; 40 (11) 2385-2393
    CrossrefPubMedSearch in Google Scholar
  • 12 Naglich A, Van Enkevort E, Adinoff B, Brown ES. Association of biological markers of alcohol consumption and self-reported drinking with hippocampal volume in a population-based sample of adults. Alcohol Alcohol 2018; 53 (05) 539-547
    CrossrefPubMedSearch in Google Scholar
  • 13 Seo Y, Aonuma K. Gamma-glutamyl transferase as a risk biomarker of cardiovascular disease　- does it have another face?. Circ J 2017; 81 (06) 783-785
    CrossrefPubMedSearch in Google Scholar
  • 14 Ndrepepa G, Colleran R, Kastrati A. Gamma-glutamyl transferase and the risk of atherosclerosis and coronary heart disease. Clin Chim Acta 2018; 476: 130-138
    CrossrefPubMedSearch in Google Scholar
  • 15 Kotani K, Tsuzaki K, Sakane N. The relationship between gamma-glutamyltransferase (GGT), bilirubin (Bil) and small dense low-density lipoprotein (sdLDL) in asymptomatic subjects attending a clinic for screening dyslipidaemias. Ann Acad Med Singapore 2014; 43 (04) 216-219
    PubMedSearch in Google Scholar
  • 16 Bharani V, Ramesh V, Rao RN, Tewari S. Evaluation of gamma glutamyl transferase as a marker of cardiovascular risk, in 200 angiographically proven coronary artery disease patients. Indian Heart J 2017; 69 (03) 325-327
    CrossrefPubMedSearch in Google Scholar
  • 17 Sheikh M, Tajdini M, Shafiee A. , et al. Association of serum gamma-glutamyl-transferase and premature coronary artery disease. Neth Heart J 2017; 25 (7-8): 439-445
    CrossrefPubMedSearch in Google Scholar
  • 18 Mao Y, Qi X, Xu W. , et al. Serum gamma-glutamyl transferase: a novel biomarker for coronary artery disease. Med Sci Monit 2014; 20: 706-710
    CrossrefPubMedSearch in Google Scholar
  • 19 Ndrepepa G, Braun S, Schunkert H, Laugwitz KL, Kastrati A. Gamma-glutamyl transferase and prognosis in patients with coronary artery disease. Clin Chim Acta 2016; 452: 155-160
    CrossrefPubMedSearch in Google Scholar
  • 20 Iijima R, Ndrepepa G, Mehilli J. , et al. Relationship between platelet count and 30-day clinical outcomes after percutaneous coronary interventions. Pooled analysis of four ISAR trials. Thromb Haemost 2007; 98 (04) 852-857
    Thieme ConnectPubMedSearch in Google Scholar
  • 21 Wada H, Dohi T, Miyauchi K. , et al. Mean platelet volume and long-term cardiovascular outcomes in patients with stable coronary artery disease. Atherosclerosis 2018; 277: 108-112
    CrossrefPubMedSearch in Google Scholar
  • 22 Wasilewski J, Desperak P, Hawranek M. , et al. Prognostic implications of mean platelet volume on short- and long-term outcomes among patients with non-ST-segment elevation myocardial infarction treated with percutaneous coronary intervention: a single-center large observational study. Platelets 2016; 27 (05) 452-458
    CrossrefPubMedSearch in Google Scholar
  • 23 Isik T, Kurt M, Tanboga IH. , et al. The impact of admission red cell distribution width on long-term cardiovascular events after primary percutaneous intervention: a four-year prospective study. Cardiol J 2016; 23 (03) 281-288
    CrossrefPubMedSearch in Google Scholar
  • 24 Lemoine M, Shimakawa Y, Nayagam S. , et al. The gamma-glutamyl transpeptidase to platelet ratio (GPR) predicts significant liver fibrosis and cirrhosis in patients with chronic HBV infection in West Africa. Gut 2016; 65 (08) 1369-1376
    CrossrefPubMedSearch in Google Scholar
  • 25 Ke MY, Zhang M, Su Q. , et al. Gamma-glutamyl transpeptidase to platelet ratio predicts short-term outcomes in hepatocellular carcinoma patients undergoing minor liver resection. J Surg Res 2018; 231: 403-410
    CrossrefPubMedSearch in Google Scholar
  • 26 Liu L, Lan Q, Lin L. , et al. Gamma-glutamyl transpeptidase-to-platelet ratio predicts the prognosis in HBV-associated acute-on-chronic liver failure. Clin Chim Acta 2018; 476: 92-97
    CrossrefPubMedSearch in Google Scholar
  • 27 Park YE, Kim BK, Park JY. , et al. Gamma-glutamyl transpeptidase-to-platelet ratio is an independent predictor of hepatitis B virus-related liver cancer. J Gastroenterol Hepatol 2017; 32 (06) 1221-1229
    CrossrefPubMedSearch in Google Scholar
  • 28 Aronow WS, Fleg JL, Pepine CJ. , et al. ACCF/AHA 2011 expert consensus document on hypertension in the elderly: a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents developed in collaboration with the American Academy of Neurology, American Geriatrics Society, American Society for Preventive Cardiology, American Society of Hypertension, American Society of Nephrology, Association of Black Cardiologists, and European Society of Hypertension. J Am Soc Hypertens 2011; 5 (04) 259-352
    CrossrefPubMedSearch in Google Scholar
  • 29 Olafsdottir E, Andersson DK, Dedorsson I, Stefánsson E. The prevalence of retinopathy in subjects with and without type 2 diabetes mellitus. Acta Ophthalmol 2014; 92 (02) 133-137
    CrossrefPubMedSearch in Google Scholar
  • 30 Joint Committee for the Revision of Guidelines for Prevention and Treatment of Dyslipidemia in Chinese Adults. Guidelines for the prevention and treatment of dyslipids in Chinese adults (Revised 2016). Zhongguo Xun Huan Za Zhi 2016; 31 (10) 937-950
    PubMedSearch in Google Scholar
  • 31 Xie X, Ma YT, Yang YN. , et al. Personalized antiplatelet therapy according to CYP2C19 genotype after percutaneous coronary intervention: a randomized control trial. Int J Cardiol 2013; 168 (04) 3736-3740
    CrossrefPubMedSearch in Google Scholar
  • 32 Park JY, Choi BG, Rha SW, Kang TS. Five-year outcomes in patients with anemia on admission undergoing a coronary intervention for acute myocardial infarction in Koreans: propensity score matching analysis. Coron Artery Dis 2018; 29 (08) 647-651
    CrossrefPubMedSearch in Google Scholar
  • 33 Guerrero C, Garay A, Ariza-Solé A. , et al. Anemia in patients with acute coronary syndromes treated with prasugrel or ticagrelor: insights from the RENAMI registry. Thromb Res 2018; 167: 142-148
    CrossrefPubMedSearch in Google Scholar
  • 34 Inouye M, Abraham G, Nelson CP. , et al; UK Biobank CardioMetabolic Consortium CHD Working Group. Genomic risk prediction of coronary artery disease in 480,000 adults: implications for primary prevention. J Am Coll Cardiol 2018; 72 (16) 1883-1893
    CrossrefPubMedSearch in Google Scholar
  • 35 Li Q, Chen L, Chen D, Wu X, Chen M. Influence of microRNA-related polymorphisms on clinical outcomes in coronary artery disease. Am J Transl Res 2015; 7 (02) 393-400
    PubMedSearch in Google Scholar
  • 36 Melo Z, Ishida C, Goldaraz MP, Rojo R, Echavarria R. Novel roles of non-coding RNAs in opioid signaling and cardioprotection. Noncoding RNA 2018; 4 (03) E22 . Doi: 10.3390/ncrna4030022
    PubMedSearch in Google Scholar
  • 37 Paolicchi A, Emdin M, Ghliozeni E. , et al. Images in cardiovascular medicine. Human atherosclerotic plaques contain gamma-glutamyl transpeptidase enzyme activity. Circulation 2004; 109 (11) 1440
    CrossrefPubMedSearch in Google Scholar
  • 38 Emdin M, Passino C, Michelassi C. , et al. Prognostic value of serum gamma-glutamyl transferase activity after myocardial infarction. Eur Heart J 2001; 22 (19) 1802-1807
    CrossrefPubMedSearch in Google Scholar
  • 39 Breitling LP, Grandi NC, Hahmann H, Wüsten B, Rothenbacher D, Brenner H. Gamma-glutamyltransferase and prognosis in patients with stable coronary heart disease followed over 8 years. Atherosclerosis 2010; 210 (02) 649-655
    CrossrefPubMedSearch in Google Scholar
  • 40 Whitman IR, Agarwal V, Nah G. , et al. Alcohol abuse and cardiac disease. J Am Coll Cardiol 2017; 69 (01) 13-24
    PubMedSearch in Google Scholar
  • 41 Mostofsky E, Chahal HS, Mukamal KJ, Rimm EB, Mittleman MA. Alcohol and immediate risk of cardiovascular events: a systematic review and dose-response meta-analysis. Circulation 2016; 133 (10) 979-987
    CrossrefPubMedSearch in Google Scholar
  • 42 Criqui MH, Thomas IC. Alcohol consumption and cardiac disease: where are we now?. J Am Coll Cardiol 2017; 69 (01) 25-27
    PubMedSearch in Google Scholar
  • 43 Lazzeri C, Valente S, Tarquini R, Chiostri M, Picariello C, Gensini GF. The prognostic role of gamma-glutamyltransferase activity in non-diabetic ST-elevation myocardial infarction. Intern Emerg Med 2011; 6 (03) 213-219
    CrossrefPubMedSearch in Google Scholar