Association of serum gamma-glutamyltransferase and premature coronary artery disease

Abstract

Background: Serum gamma-glutamyltransferase (GGT) has been introduced as a predictive factor for cardiovascular disease. In this study, we investigated the association of serum GGT and premature coronary artery disease (CAD) in candidates for coronary angiography.

Methods: In this cross-sectional study, we enrolled male subjects aged ≤45 years and female subjects ≤55 years who were candidates for elective coronary angiography due to typical chest pain or a positive non-invasive test. Baseline characteristics were recorded for all the participants and serum levels of blood glucose, lipid profile and GGT were measured. Patients were divided into CAD and non-CAD groups based on angiography for further comparisons.

Results: From a total of 367 patients (age 45.1 ± 6.1 years, 161 males [43.9%]), 176 (47.9%) patients had premature CAD. A high level of GGT was significantly associated with the presence of CAD (p < 0.001). A 10-unit increase in GGT could strongly predict the presence of premature coronary artery disease (OR: 13.34, 95% CI: 7.19-24.78; p < 0.001) after adjustment for confounders. The area under the receiver operating characteristic curve for GGT was 80.9% (range 76.5-85.3) and the sensitivity and specificity of GGT at a cut-point of 22.5 IU/l was 80.1% and 70.2%, respectively. Diagnostic accuracy of GGT was 74.9%. The positive predictive value and negative predictive value for GGT was 71.3 and 79.3, respectively.

Conclusion: We observed that GGT levels in patients with typical chest pain or positive non-invasive tests could predict the presence of premature CAD in young patients.

Keywords: Acute coronary syndrome; Coronary angiography; Gamma-glutamyltransferase; Premature coronary artery disease.

Fig. 1

The receiver operating characteristic curve for serum GGT used for screening of high-risk CAD patients. a Males (AUC = 77.1%, p < 0.001), b Females (AUC = 83.2%, p < 0.001)

Fig. 2

Box plot of GGT levels in the subgroup of patients based on the presence and extent of premature CAD as defined by vessel score (single vessel disease [SVD] is defined as stenosis [at least 50%] of LAD, LCX, RCA or a main branch of one of them, two-vessel disease [2VD] is stenosis of two coronary arteries other than the left main, and triple-vessel disease [3VD] is stenosis in three coronary arteries)