Association of Serum Gamma Glutamyl Transferase Level with Acute Coronary Syndrome and Its Correlation with Major Adverse Cardiovascular Outcomes - A Single Center Cross Sectional Study from a Tertiary Care Centre in Kerala


Baiju Rajan1, Praveen Velappan2, Abdul Salam3, Sivaprasad Kunjukrishnapillai4, Kapil Rajendran5, Binu Thankappan Gomathy6, Ashis Ranjan7, Girish8

Gamma glutamyl transferase (GGT) is a biomarker elevated in various
cardiovascular diseases due to oxidation mediated free radical damage. It has
been recently used in patients presenting with acute coronary syndromes (ACS)
for predicting major adverse cardiovascular events and in hospital adverse
outcomes. The application of gamma glutamyl transferase to the traditional set of
biomarkers like troponin I and T, creatinine kinase-MB (CKMB) adds to the value
that it helps in reclassifying the patients into high and low risk and plan the
appropriate treatment strategy.
Patients presenting with acute coronary syndromes were classified into STEMI (ST
elevation myocardial infarction), NSTEMI (Non-ST elevation myocardial infarction)
and unstable angina based on cardiac biomarkers and electrocardiographic
changes. Serum gamma glutamyl transferase of these patients were measured by
photo spectrometry and were monitored for 5 days for major adverse
cardiovascular events.
Of the study population (N = 210), 41 % presented with STEMI, 24 % unstable
angina, 25 % NSTEMI. The normal range of GGT in our study population was 15
- 70 U/l. values more than 70 U/l was considered raised GGT major adverse cardiac
events (MACE) was present in 35 % of the study population. 58 % of the patients
with MACE had raised GGT (> 70 U/l) which was statistically significant (P <
0.001). The ROC (receiver operator characteristic curve) for GGT to predict MACE
was to the left of the reference line and the area under the curve (AUC) was 0.915.
The optimal cut-off for GGT to predict MACE from our study was 50.5 with a
sensitivity and specificity of 0.813 and 0.868 respectively.
Raised GGT was significantly associated with MACE and in hospital adverse
outcomes (ventricular arrythmias, heart failure, recurrent angina). GGT can be
used as a prognostic marker in patients presenting with ACS.