Urinary neutrophil gelatinase-associated lipocalin and clinical outcomes in patients with acute coronary syndrome: a focus on patients with impaired ejection fraction.

Authors

Yodo Gatate, Mitsunobu Nagai, Keisuke Matsuo, Hiroki Hoya, Saki Hasegawa-Tamba, Michiru Nomoto, Takahide Arai, Shintaro Nakano

Published in

Coronary artery disease. Oct 16, 2026. Epub Oct 16, 2026.

Abstract

To evaluate the prognostic value of urinary neutrophil gelatinase-associated lipocalin (NGAL) normalized to creatinine in patients with acute coronary syndrome (ACS), focusing on left ventricular ejection fraction (LVEF).
This retrospective cohort study included 144 patients emergently admitted for ACS, with urinary NGAL measured 4-48 h postadmission. Primary and secondary outcomes were all-cause mortality and major adverse cardiovascular and cerebrovascular events (MACCEs), respectively. Optimal NGAL/creatinine cutoffs were determined using receiver operating characteristic analysis. Associations between urinary NGAL/creatinine and clinical outcomes were evaluated using Cox proportional hazards models.
During a median 734.5-day follow-up, 8 deaths and 44 MACCE occurred. The optimal NGAL/creatinine cutoff for predicting MACCE was 20.85 ng/mg creatinine. All deaths occurred in the high NGAL/creatinine group (≥20.85), but mortality analyses were limited by statistical separation. High NGAL/creatinine was significantly associated with MACCE (hazard ratio = 3.47, 95% confidence interval = 1.61-7.47) and remained associated with a higher event hazard after adjustment for age, brain natriuretic peptide, LVEF, and estimated glomerular filtration rate (adjusted hazard ratio = 2.75; P = 0.017). In subgroup analyses, the area under the curve for MACCE was numerically higher in patients with LVEF <50% than in those with LVEF ≥50% (0.753 vs. 0.581). Formal interaction testing in the Cox model, however, did not demonstrate significant effect modification by LVEF category (P for interaction = 0.100).
Urinary NGAL/creatinine was significantly associated with long-term MACCE in patients with ACS. Although subgroup analyses showed numerically different associations according to LVEF, formal interaction testing did not demonstrate significant effect modification by LVEF.

PMID:
42888882
Bibliographic data and abstract were imported from PubMed on 17 Oct 2026.

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