NGAL and Its Association With the No-reflow Phenomenon in ST-elevation Myocardial Infarction

Study Overview
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Brief Summary
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The aim of this study is to investigate the association between NGAL plasma levels in ST-elevation myocardial infarction and the no-reflow phenomenon, adverse events during hospitalization and at 30-day follow-up.

Detailed Description
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Neutrophil Gelatinase-associated Lipocalin (NGAL) is a acute phase protein which is elevated in conditions like acute kidney injury and myocardial infarction. When a coronary artery is occluded, detrimental changes occur in myocardial vessels. After relief of the occlusion, blood flow to the heart may still be impeded, a phenomenon known as no-reflow. Data is lacking on factors associated with early detection of patients at risk for this phenomenon, and early stratification of this group seems vital since the no-reflow phenomenon is associated with worse outcomes. The investigators hypothesized that there might be an association between higher NGAL levels and the occurrence of no-flow findings, and that NGAL might serve as a marker of worse prognosis in this population. The investigators also hypothesized that NGAL levels might serve as a marker of early acute kidney injury and that there might be specific patterns of NGAL levels over time in different subsets of patients. The aim of the study is to determine the association between NGAL levels at admission and during the first days after a ST-elevation myocardial infarction, the occurrence of the no-reflow phenomenon, the extent of myocardial damage ascertained by cardiac imaging techniques (echocardiography and cardiac resonance imaging). Data regarding patients' clinical, laboratory, electrocardiogram, coronary angiography and percutaneous coronary intervention, in-hospital and 30-day follow-up after discharge will be recorded.

Official Title
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Neutrophil Gelatinase-associated Lipocalin (NGAL) and Its Association With the No-reflow Phenomenon in ST-elevation Myocardial Infarction

Conditions
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No-Reflow Phenomenon, STEMI - ST Elevation Myocardial Infarction

Intervention / Treatment
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* Diagnostic Test: NGAL levels early and post STEMI


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients > 18 years old presenting with ST-elevation myocardial infarction and undergoing urgent coronary angiography with or without PCI. Signed informed consent to participate in the study. Exclusion Criteria: Inability to sign written informed consent. Chronic renal failure (eGFR < 30 ml/min/1.73m2).

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Intervention/Treatment |
| --- |
|Diagnostic Test: NGAL levels early and post STEMI|NGAL levels early and post ST elevation MI (STEMI)|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| No-reflow phenomenon after STEMI | No-reflow phenomenon as defined by electrocardiographic, angiographic and cardiac magnetic resonance imaging criteria. | During hospitalization | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| In-hospital MACE(major adverse cardiac events) | In-hospital MACE | Average day 5 of hospitalization and before discharge | 
| 30-day MACE | 30-day MACE | 30-day follow-up | 
| Serial creatinine level | Creatinine levels as a maker of acute kidney injury reported in mg/dl | On admission and at fixed time intervals (first 3 hours after admission, 12 hours, 24 hours and every 24 hours or before if indicated) | 
| The need for renal replacement therapy after STEMI | Patients started on hemodyalisis due to acute kidney injury during the index hospitalization | In-hospital (usually 5 days) | 
| Recurrent hospitalization | Recurrent hospitalization at 30 days after the index hospitalization | 30 days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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NGAL, STEMI, no-reflow, PCI (Percutaneous Coronary Intervention)