Neutrophil Gelatinase-Associated lipocalin (NGAL) for the Assessment of Early Renal Tubular Damage in ST-Segment Elevation Myocardial Infarction Patients Treated with Primary Percutaneous Coronary Intervention

Background: Neutrophil gelatinase-associated lipocalin (NGAL) is a glycoprotein released by renal tubular cells upon nephrotoxic or ischemic events and is considered an early marker of tubular damage. We aimed to demonstrate the presence of early renal injury detected by elevated NGAL levels taken prior to contrast administration in ST segment elevation myocardial infarction (STEMI) patients undergoing primary coronary intervention (PCI).

Methods: We prospectively included 88 patients with STEMI treated with PCI. Blood samples for plasma NGAL were drawn immediately before PCI (baseline NGAL; NGAL1) and 24 hours after PCI (NGAL 2). Abnormal elevation of NGAL levels were defined using the cardiac surgery associated NGAL score (CSA-NGAL score) with NGAL levels ≥100ng/ml suggesting renal tubular damage. Patients were also assessed for the dynamics between NGAL2 and NGAL 1 levels.

Results: Mean age was 62 ±13 years and 78% were men. A total of 50/88 patients (56%) had baseline NGAL level≥100suggesting possible tubular damage prior to PCI. Only 10 patients progressed to clinical acute kidney injury during hospitalization, all of whom had baseline NGAL level ≥100 (P<0.001).Among patients having baseline NGAL ≥100, 28/50 (56%) demonstrated a decrease in NGAL level within 24 hours, while only 9/50 (18%) demonstrated an elevation in NGAL level. In contrast, only 7/38 patients (19%) having baseline NGAL level

Conclusions: Elevated NGAL levels prior to primary PCI suggesting renal tubular damage are common among STEMI patients. Further trials are needed in order to assess the complex cardio-renal interactions.