Table 2.
Association between NGAL and MACE in patients with ACS
| Study | Population | Reporting of effect | Endpoint and follow-up | Univariate analysis | Multivariate analysis | ||
|---|---|---|---|---|---|---|---|
| Unadjusted effect (95% CI) | p-value | Adjusted effect (95% CI) | p-value | ||||
| Liu et al. (2021) [48] | n = 633 patients with MI and SA | Per 1 SD increase | CV death at 10 years† | HR 2.74 (1.75–5.37) | < 0.001 | HR 2.62 (1.51–4.96) | < 0.001 |
| Avci et al. (2020) [47] | n = 68 patients with STEMI | Grouped via median | CV death at 6 months† | 357 (71–694) vs. 120 (9–513) ng/mL‡ | < 0.001 | β±SE 0.017 ± 0.007, (5.59)2 | 0.01 |
| Obeid et al. (2020) [53] | n = 1832 patients with MI | Per 1 ng/mL increase | All-cause death† and composite of death, MI, cerebrovascular events or revascularisation at 1 year† | OR 1.01 (1.007–1.013), all-cause death | < 0.001 | HR 1.003 (0.999–1.008), all-cause death | 0.16 |
| OR 1.006 (1.003–1.008), MACE | < 0.001 | HR 1.001 (0.998–1.005), MACE | 0.48 | ||||
| Nguyen et al. (2019) [44] | n = 701 STEMI patients treated with PCI | Grouped via highest vs. lowest tertile | All-cause death at 1 year‡ | OR 2.4 (1.53–3.89) | < 0.0001 | OR NR | NS |
| Peng et al. (2019) [49] | n = 422 NSTEMI patients with CTO | Grouped by ROC threshold (7-day NGAL) | Composite of CV death, cardiogenic shock, ischemic stroke or revascularisation at 2 years† | 2.70 ± 1.11 vs. 2.21 ± 0.83 ng/mL‡ | < 0.001 | OR 2.01 (1.45–2.79) | < 0.001 |
| Nymo et al. (2018) [52] | n = 1121 MI patients | Grouped by highest quartile vs. others | All-cause death during median 13.9 years† | HR 1.93 (1.63–2.28) | < 0.001 | HR 1.63 (1.31–2.03) | < 0.001 |
| Barbarash et al. (2017) [54] | n = 357 patients with STEMI | Grouped by lowest quartile vs. others | CV death† and composite of CV death, MI, and hospitalisation due to UA, stroke or acute HF at 3 years† | 2.36 vs. 1.61 ng/mL‡, CV mortality | 0.02 | OR NR, CV death | NS |
| 2.04 vs. 1.48 ng/mL‡, MACE | 0.01 | OR 2.9 (1.4–6.0), MACE | 0.003 | ||||
| Helanova et al. (2015) [51] | n = 673 patients with STEMI | Grouped by ROC threshold | All-cause death at 1 year during median 2.7 years† | OR 1.939 (1.31–2.86) | < 0.001 | OR 1.616 (1.027–2.543) | 0.038 |
| Akcay et al. (2012) [50] | n = 106 patients with STEMI undergoing PCI | 1Per 1 ng/mL increase; 2grouped via median | All-cause death† and composite of death, non-fatal MI, revascularisation or new CHF at 1 year† | HR 1.13 (1.08–1.25)1; 1.18 (1.09–1.37)2, all-cause death | < 0.0011; < 0.012 | HR 1.10 (1.06–1.22)1, all-cause death | 0.011 |
| HR 1.09 (1.04–1.19)1, MACE | 0.021 | ||||||
| HR 1.11 (1.04–1.24)1; 1.20 (1.12–1.34)2, MACE | < 0.011; < 0.012 | HR 1.19 (1.06–1.22)2, all-cause death | 0.012 | ||||
| HR 1.17 (1.08–1.27)2, MACE | 0.012 | ||||||
| Lindberg et al. (2012) [35] | n = 584 patients with STEMI treated with PCI | Grouped by highest quartile vs. others | All-cause death† and composite of CV death or hospitalisation due to MI or HF during median 23 (20–24) months† | Log rank‡, all-cause death | < 0.001 | HR 2.00 (1.16–3.44), all-cause death | 0.01 |
| Log rank‡, MACE | < 0.001 | HR 1.51 (1–2.3), MACE | 0.05 | ||||
| Yndestad et al. (2009) [40] | n = 236 MI patients with acute HF | Grouped via median | Composite of all-cause or CV death, MI or stroke during median 27 months† | Log rank‡ | < 0.001 | OR NR | S |
Abbreviations: ACEi, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; β ± SE, beta coefficient ± standard error; BMI, body mass index; BNP, brain natriuretic protein; BP, blood pressure; CAD, coronary artery disease; CRP, C-reactive protein; cTnI, cardiac Troponin I; cTnT, cardiac Troponin T; CV, cardiovascular; DM, diabetes mellitus; eGFR, estimated glomerular filtration rate; FBG, fasting blood glucose; GRACE, Global Registry of Acute Coronary Events; HF, heart failure; HFpEF, HF with preserved ejection fraction; HFrEF, HF with reduced ejection fraction; HR, hazards ratio; hsCRP, high-sensitivity CRP; LVEDD, left ventricular end-diastolic diameter; LVEF, left ventricular ejection fraction; MI, myocardial infarction; NGAL, neutrophil gelatinase-associated lipocalin; NR, not reported; NS, not significant (p < 0.05); OR, odds ratio; PCI, percutaneous coronary intervention; S, p-value is statistically significant (unspecified); SA, stable angina; 95% CI, 95% confidence interval; TIMI, Thrombolysis in Myocardial Infarction; WBC, white blood cell
†Indicates a primary endpoint; ‡indicates concentration is represented as median (IQR) or mean ± SD for cases versus controls, respectively; 1denotes continuous variables were assessed per unit change in concentration, as specified; 2denotes endpoints were compared in patients stratified according to pre-specified categories of biomarker concentration. Statistical significance was considered as two-tailed p ≤ 0.05 (bolded)