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Effect of Serum Gamma-Glutamyl Transferase Levels on Myocardial Perfusion and Long-Term Prognosis After Primary Angioplasty in Patients With Acute ST-Elevation Myocardial Infarction
  1. Firat Ozcan, MD*,
  2. Mehmet Fatih Karakas, MD,
  3. Mehmet Fatih Ozlu, MD*,
  4. Adnan Burak Akcay, MD,
  5. Eyup Buyukkaya, MD,
  6. Mustafa Kurt, MD,
  7. Gonul Erden, MD,
  8. Huseyin Yuzgecer, MD*,
  9. Metin Yildirimkaya, MD,
  10. Edjon Hajro, MD*,
  11. Yucel Balbay, MD*,
  12. Mevlut Koc, MD§,
  13. Huseyin Ugur Yazici, MD,
  14. Nihat Sen, MD
  1. From the *Department of Cardiology, Yuksek Ihtisas Education and Research Hospital, Ankara; †Department of Cardiology, Mustafa Kemal University, Tayfur Ata Sokmen Medical School, Hatay; ‡Department of Clinical Biochemistry, Ankara Numune Research and Training Hospital, Ankara; §Department of Cardiology, Adana Numune Education and Research Hospital, Adana; and ∥Department of Cardiology, Medicine Faculty of Osmangazi University, Eskisehir, Turkey.
  1. Received April 17, 2012, and in revised form June 27, 2012.
  2. Accepted for publication July 3, 2012.
  3. Reprints: Mehmet Fatih Karakas, MD, Department of Cardiology, Mustafa Kemal University, Tayfur Ata Sokmen Medical School, Serinyol, Antakya 31005, Turkey. E-mail: mfkarakas{at}
  4. This work received no funding support.
  5. The authors have no conflicts of interest to declare.


Background Gamma-glutamyl transferase (GGT) level was found to be elevated in plasma of patients with cardiovascular risk factors. The aim of our study was to assess the relationship between serum GGT levels and the occurrence of no-reflow as well as to evaluate the prognostic value of GGT in ST-segment elevation myocardial infarction (STEMI) population.

Methods and Results One hundred sixty-eight consecutive patients with STEMI who underwent percutaneous coronary intervention (PCI) were enrolled in the study. Patients with STEMI were grouped into tertiles according to their admission serum GGT levels. No-reflow after PCI was assessed both angiographically (thrombolysis in myocardial infarction [TIMI] flow and myocardial blush grade) and electrocardiographically (ST resolution). Gamma-glutamyl transferase levels were higher in patients with STEMI compared to the elective PCI group subjects. Patients with angiographically (TIMI flow ⩽2 or TIMI flow 3 with final myocardial bush grade ⩽2 after PCI) and electrocardiographically (ST resolution <30%) detected no-reflow were increased in number across the GGT tertiles. In addition, 1-year mortality rates showed a significant increase across the tertile groups (4% vs 11% vs 23%, P < 0.01). Multivariable logistic regression analysis revealed that GGT levels on admission were a significant predictor of long-term mortality of myocardial blush grade–detected no-reflow phenomenon. High GGT level on admission was a significant predictor for long-term mortality and major adverse cardiac events.

Conclusions In patients with STEMI undergoing primary PCI, high GGT levels at admission were found to be associated with no-reflow phenomenon and increased long-term mortality.

Key Words
  • gamma-glutamyl transferase
  • ST-segment elevation myocardial infarction
  • no-reflow
  • mortality
  • primary percutaneous coronary intervention

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