Beyond conventional markers: Navigating the complex prognostic landscape of galectin-3 and Lp(a) in predicting MACE in post-PTCA procedure
F R Qhabibi, D R Desandri, B Dwiputra, R Hamdani, M Ridwan, A B Hartopo, C T Tjahjono, B B Tiksnadi, H Hasan, A M AmbariAbstract
Background
Low-density lipoprotein (LDL) is the primary predictor of cardiovascular disease (CVD); nevertheless, several studies in specific populations have indicated that lipoprotein(a) (Lp(a)) and galectin-3 possess predictive capabilities for CVD. No direct comparative data on LDL, Lp(a), and Galectin-3 in Indonesians exists under specific circumstances.
Objective
Hence, the study analyses plasma levels of galectin-3, Lp(a), and LDL in secondary prevention patients post percutaneous transluminal coronary angioplasty (PTCA) to forecast cardiac events.
Methods
A multicenter prospective cohort conducted in 7 centers in Indonesia. The participants were individuals who had previously undergone an elective PTCA within the past 6 - 24 months. Participants were monitored for 12 months; also, the patients who experienced re-hospitalization and mortality related to CVD during the follow-up period were counted as cardiac events. The values of all predictors are classified into a binary variable with cut-off thresholds of 23.5 ng/mL and 21.95 mg/dL for galectin-3 and Lp(a), respectively, based on the Youden index calculation. Also, the cut-off 55 mg/dL for LDL is based on recent guidelines. Univariate and multivariate Cox proportional hazard regression were employed to estimate the hazard ratio (HR) of the predictors and 13 covariates. The prognostic value between galectin-3 and Lp(a) towards cardiac events was analyzed using Kaplan-Meier and receiver operating characteristic (ROC) curves.
Results
Cox proportional hazards regression analysis involving 145 post-PTCA patients across 7 centers in Indonesia indicates that galectin-3 is a considerably superior predictor for assessing the prognosis of cardiac events (HR: 6.70; p: 0.005; 95% CI: 1.8 - 25.2) followed by Lp(a) (HR: 4.72; p:0.022; 95% CI: 1.2 - 17.8). Incongruously, the ability of LDL in assessing a cardiac event in post-PTCA patients is deemed insignificant (HR: 0.68; p:0.56; 95% CI: 0.18 - 2.55). Moreover, the ROC curve showed that galectin-3 had the highest area under the curve (AUC) compared to Lp(a), and LDL with 0.733 (p: 0.004), 0.692 (p: 0.019), and 0.461 (p: 0.675), respectively.
Conclusion
Galectin-3 and Lp(a) showed a superiority in predicting cardiac events compared to LDL in post-PTCA patients who are undergoing a secondary prevention program in Indonesia.Graphycal Abstract