Introduction: Atherosclerosis is the predominant cause of acute coronary syndrome, and is usually associated with rupture of an atherosclerotic plaque resulting in the formation of partial or complete thrombosis of the coronary artery. The main objective of the study is to compare the levels of biochemical marker of atherosclerosis-gamma-glutamyl transferase (GGT) and sensitive marker of myocardial necrosis-cardiac Troponin-I (cTnI) in patients presenting with acute coronary syndrome (ACS). Materials and methods: The design was a prospective casecontrol study where a total of 161 patients, 110 ACS patients and 51 control subjects with the age group of 30 to 80 years were enrolled for the study. GGT was estimated by kinetic colour test using Beckman Coulter AU2700 analyser. Troponin-I was estimated by chemiluminescent micro particle immunoassay using Abbott ARCHITECT system. Results: The mean GGT levels of ST-segment elevation myocardial infarction (STEMI), non-ST-segment elevation myocardial infarction (NSTEMI) and unstable angina (UA) subgroups were 91.58, 84.12 and 30.46 U/L respectively, which showed a statistically significant difference (p < 0.001) when compared with control subjects. The mean Troponin-I levels of STEMI, NSTEMI and UA subgroups were 14.31, 4.68 and 0.02 ng/mL respectively, which showed a statistically significant difference (p < 0.001) when compared with control subjects. Correlation between GGT and Troponin-I done using Spearman\'s Rho coefficient correlation test showed a positive correlation between GGT and Troponin-I in ACS patients. Conclusion: Gamma-glutamyl transferase (GGT) level elevates as an indicator of increased oxidative stress in patients with coronary artery disease who are not alcoholic and have no liver disease. The strong correlation between GGT and Troponin-I complement the usefulness of gamma-glutamyl transferase for predicting troponin positivity in patients presenting with acute coronary syndrome.
Grech ED, Ramsdale DR. Acute coronary syndrome: unstable angina and non-ST segment elevation myocardial infarction. BMJ 2003 Jun;326(7401):1259-1261.
Mackman N. Triggers, targets and treatment for thrombosis. Nature 2008 Feb;451(7181):914-918.
Hajjar DP, Gotto AM Jr. Biological relevance of inflammation and oxidative stress in the pathogenesis of arterial diseases. Am J pathol 2013 May;182(5):1474-1481.
Alpert JS, Thygesen K, Antman E, Bassand JP. Myocardial infarction redefined: a consensus document of the Joint European Society of Cardiology/American College of Cardiology Committee for the Redefinition of Myocardial Infarction. J Am Coll Cardiol. 2000 Sep;36(3):959-969.
Jaffe AS, Ravkilde J, Roberts R, Naslund U, Apple FS, Katus H. It's time for a change to a troponin standard. Circulation 2000 Sep;102(11):1216-1220.
Emdin M, Passino C, Pompella A, Paolicchi A. Gammaglutamyl transferase as a cardiovascular risk factor. Eur Heart J 2006 Sep;27(18):2145-2146.
Paolicchi A, Minotti G, Tonarelli P, Tongiani R, De Cesare D, Mezzetti A, et al. Gamma-glutamyl transpeptidase-dependent iron reduction and LDL oxidation–a potential mechanism in atherosclerosis. J Investig Med 1999 Mar;47(3):151-160.
Kazemi-Shirazi L, Endler G, Winkler S, Schickbauer T, Wagner O, Marsik C. Gamma glutamyl transferase and long-term survival: is it just the liver? Clin Chem 2007 May;53(5):940-946.
Turgut O, Tandogan I, Gurlek A. Association of gammaglutamyl transferase with cardiovascular risk: a prognostic outlook. Arch Med Res 2009 May;40(4):318-320.
Paolicchi A, Emdin M, Passino C, Lorenzini E, Titta F, Marchi S, et al. Beta-lipoprotein- and LDL-associated serum gammaglutamyl transferase in patients with coronary atherosclerosis. Atherosclerosis. 2006 May;186(1):80-85.
Emiroglu MY, Esen OB, Bulut M, Karapinar H, Kaya Z, Akcakoyun M, et al. Gamma glutamyl transferase levels and its association with high sensitive C-reactive protein in patients with acute coronary syndromes. N Am J Med Sci 2010 Jul;2(7):306-310.
Shabbir S, Khan DA, Khan FA, Elahi MM, Matata BM. Serum gamma glutamyl transferase: a novel biomarker for screening of premature coronary artery disease. Cardiovascular Revascularization Medicine 2011 Nov-Dec;12(6):367-374.
Pompella A, Emdin M, Passino C, Paolicchi A. The significance of serum gamma glutamyl transferase in cardiovascular diseases. Clin Chem Lab Med 2004 Oct;42(10):1085-1091.
Ruttmann E, Brant LJ, Concin H, Diem G, Rapp K, Ulmer H. Gamma glutamyl transferase as a risk factor for cardiovascular disease mortality: an epidemiological investigation in a cohort of 163,944 Austrian adults. Circulation 2005 Oct;112(14):2130-2137.
Wannamethee SG, Ebrahim S, Shaper AG. Gamma-glutamyl transferase: determinants and association with mortality from ischemic heart disease and all causes. Am J Epidemiol 1995 Oct;142(7):699-708.
Emdin M, Passino C, Michelassi C, Titta F, L'abbate A, Donato L, et al. Prognostic value of serum gamma-glutamyl transferase activity after myocardial infarction. Eur Heart J 2001 Oct;22(19):1802-1807.
Sheridan PJ, Crossman DC. Critical review of unstable angina and non-ST elevation myocardial infarction. Postgraduate Med J 2002 Dec;78(926):717-726.
Antman EM, Tanasijevic MJ, Thompson B, Schactman M, McCabe CH, Cannon CP, et al. Cardiac-specific troponin I levels to predict the risk of mortality in patients with acute coronary syndromes. N Engl J Med 1996 Oct;335(18):1342-1349.
Heidenreich PA, Alloggiamento T, Melsop K, McDonald KM, Go AS, Hlatky MA. The prognostic value of troponin in patients with non-ST elevation acute coronary syndromes: a meta-analysis. J Am Coll Cardiol 2001 Aug;38(2):478-485.
Christenson RH, Vollmer RT, Ohman EM, Peck S, Thompson TD, Duh SH, et al. Relation of temporal creatine kinase-MB release and outcome after thrombolytic therapy for acute myocardial infarction. TAMI Study Group. Am J Cardiol 2000 Mar;85(5):543-547.
Chia S, Senatore F, Raffel OC, Lee H, Wackers FJ, Jang IK. Utility of cardiac biomarkers in predicting infarct size, left ventricular function, and clinical outcome after primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. JACC Cardiovasc Interv 2008 Aug;1(4):415-423.
Alexander JH, Sparapani RA, Mahaffey KW, Deckers JW, Newby LK, Ohman EM, et al. Association between minor elevations of creatine kinase-MB level and mortality in patients with acute coronary syndromes without STsegment elevation. PURSUIT Steering Committee. Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy. JAMA 2000 Jan;283(3): 347-353.
Roe MT, Peterson ED, Li Y, Pollack CV Jr, Christenson RH, Peacock WF, et al. Relationship between risk stratification by cardiac troponin level and adherence to guidelines for non- ST-segment elevation acute coronary syndromes. Arch Intern Med 2005 Sep;165(16):1870-1876.
Demirelli S, Firtina S, Askin L, Akgol Gur ST, Akgol Gur ST, Tanrikulu CS, Ermis E, et al. Utility of -Glutamyl Transferase in Predicting Troponin Elevation in Emergency Departments. Angiology 2016 Sep;67(8):737-741.
Valjevac A, Rebic D, Hamzic-Mehmedbasic A, Sokolovic E, Horozic D, Vanis N, Hadzovic-Dzuvo A. The value of gamma glutamyltransferase in predicting myocardial infarction in patients with acute coronary syndrome. Future Cardiol 2018 Jan;14(1):37-45.