Neutrophil gelatinase-associated lipocalin (NGAL) has been proposed as an early marker for estimating the risk of contrast-induced acute kidney injury (CI-AKI). However, the predictive value of baseline serum NGAL levels for CI-AKI remains unclear. Serum NGAL was measured before percutaneous coronary intervention in 633 patients with coronary artery disease. The primary clinical endpoints were a composite of major adverse cardiac and cerebrovascular events (MACCEs; cardiac death, myocardial infarction, stroke, and any revascularization). The mean follow-up duration was 29.4 months. Ninety-eight (15.5%) patients developed CI-AKI. Compared with patients without CI-AKI, baseline serum NGAL was higher in patients with CI-AKI (149.6 ± 88.8 ng/mL vs. 138.0 ± 98.6 ng/mL, p = 0.0279), although serum creatinine and estimated glomerular filtration rate were not different between groups. Patients in the highest tertile of baseline serum NGAL showed a significantly higher rate of MACCEs (10.5% vs. 3.8%, p = 0.02). Using the first tertile as a reference, the adjusted hazard ratios for MACCEs in patients in the second and third tertiles of NGAL were 2.151 (confidence interval (CI) 0.82 to 5.59, p = 0.116) and 2.725 (CI 1.05 to 7.05, p = 0.039), respectively. Baseline serum NGAL is a reliable marker for predicting CI-AKI, and high serum NGAL levels are associated with a higher incidence rate of long term MACCEs.

An elevated heart rate at admission or discharge is known to be associated with poor cardiovascular outcomes in patients with acute myocardial infarction (AMI). The association between post-discharge average office-visit heart rate and cardiovascular outcomes in patients with AMI has rarely been studied. We analyzed data for 7840 patients from the COREA-AMI registry who had their heart rates measured at least three times after hospital discharge. The office-visit heart rates were averaged and categorized into four groups by quartiles (80 beats per minute). The primary end point was a composite of cardiovascular death, myocardial infarction, and ischemic stroke. During a median of 5.7 years of follow-up, major adverse cardiovascular events (MACE) affected 1357 (17.3%) patients. An average heart rate higher than 80 bpm was associated with an increased incidence of MACE compared to the reference average heart rate of 68–74 bpm. When dichotomized into <74 or ≥74 bpm, a lower average heart rate was not associated with MACE in patients with LV systolic dysfunction, in contrast to those without LV systolic dysfunction. An elevated average heart rate at office visits after AMI was associated with an increased risk of cardiovascular outcomes. Heart rate monitoring at office visits after discharge provides an important predictor related to cardiovascular events.

Byeon J, et al. Korean Circ J. 2025 Oct;56:e16. https://doi.org/10.4070/kcj.2025.0344

Background and Objectives: Pharmacological classes recommended for heart failure (HF) are also prescribed for indications other than HF. Their use in heterogeneous cardiovascular critical-care populations therefore does not necessarily represent HF-directed guideline-directed medical therapy. We examined the association between in-hospital exposure to these medication classes and in-hospital mortality, without assuming HF-specific treatment indications or causal treatment effects. Materials and Methods: This retrospective multicenter cohort included 8622 adults in a cardiovascular critical-care dataset with admission dates from June 2014 to October 2021. Exposure was defined as administration during at least 50% of the index hospitalization of each of four medication classes: a renin–angiotensin system inhibitor or angiotensin receptor–neprilysin inhibitor (counted as one class), a β-blocker, a mineralocorticoid receptor antagonist, and a sodium–glucose cotransporter 2 inhibitor. Patients were categorized by exposure to 0–1, 2, or ≥3 classes. The primary outcome was in-hospital mortality. Multivariable logistic regression adjusted for age, sex, hypertension, diabetes mellitus, documented HF, chronic kidney disease, and admission systolic blood pressure >100 mmHg. Results: Among 8622 patients, only 8.2% had documented HF; 6985 were exposed to 0–1 medication classes, 1388 to 2 classes, and 249 to ≥3 classes. Crude in-hospital mortality was 9.46%, 2.09%, and 3.21%, respectively (overall p < 0.001). Compared with the 0–1-class group, the adjusted odds ratios (ORs) for mortality were 0.19 (95% confidence interval [CI], 0.13–0.28) for 2 classes and 0.25 (95% CI, 0.12–0.53) for ≥3 classes. Documented HF prevalence and N-terminal pro–B-type natriuretic peptide (NT-proBNP) levels increased across exposure categories, indicating differences in clinical phenotype and likely treatment selection. Conclusions: In a heterogeneous cardiovascular critical-care cohort, greater in-hospital exposure to pharmacological classes commonly recommended for HF was associated with lower observed in-hospital mortality relative to exposure to 0–1 classes. However, medication indications were unavailable, the association was not strictly monotonic, and treatment eligibility, clinical stability, and survivor-treatment or immortal-time bias may substantially explain the findings. These descriptive, hypothesis-generating results neither establish treatment benefit nor justify HF-specific pharmacotherapy in patients without an appropriate indication.

Korean Circulation Journal 대한심장학회지 순환기 Byeon J, et al. Korean Circ J. 2022 Feb;52:e32. https://doi.org/10.4070/kcj.2021.0392

Background and Objectives: Soluble suppression of tumorigenicity-2 (sST2) is a biomarker associated with myocardial stress, inflammation, and fibrosis. Although elevated sST2 levels have demonstrated prognostic significance in heart failure and acute coronary syndromes, their clinical relevance in patients undergoing percutaneous coronary intervention (PCI) remains incompletely defined. This study aimed to evaluate the association between baseline serum sST2 levels and long-term clinical outcomes in an unselected real-world cohort of patients undergoing PCI. Materials and Methods: A total of 758 consecutive patients with coronary artery disease who underwent PCI between September 2015 and November 2017 were enrolled. Baseline serum sST2 levels were measured before PCI, and patients were stratified according to the median value (28.3 ng/mL). The primary endpoint was major adverse cardiac and cerebrovascular events (MACCEs), defined as a composite of cardiac death, nonfatal myocardial infarction, and nonfatal stroke. Multivariable Cox proportional hazards models and receiver operating characteristic analyses were performed to assess the association of sST2 with clinical outcomes and its discriminatory ability. Results: During a median follow-up of 28.3 months, MACCEs occurred in 19 patients (2.5%). Patients with higher sST2 levels had significantly higher rates of MACCEs (4.2% vs. 0.8%, p = 0.005) and all-cause mortality (11.9% vs. 2.6%, p < 0.001) than those with lower sST2 levels. Although the association between elevated sST2 and MACCE was attenuated after multivariable adjustment (adjusted hazard ratio, 3.28; 95% confidence interval, 0.91–11.83; p = 0.070), receiver operating characteristic analysis demonstrated moderate predictive performance for MACCE (AUC, 0.723) and all-cause mortality (AUC, 0.763). The optimal cutoff value for predicting MACCE was 52.2 ng/mL. Conclusions: Elevated baseline serum sST2 levels were associated with adverse long-term clinical outcomes in an unselected, real-world cohort of patients undergoing PCI. Further studies are warranted to clarify its prognostic role in this population.