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Review

The Prognostic Value of Pre-Procedural and Post-Procedural Inflammatory–Oxidative Stress Biomarkers in Acute Coronary Patients Undergoing Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis

by
Jonathan Samuel Matogu Tambunan
1,
Citrawati Dyah Kencono Wungu
2,3,*,
Hendri Susilo
4,5,6,
Azizah Bonitha Zahrah Santoso
1,
Anindita Azkia Fauzana
1,
Pramudya Dhafa Hernandi
1,
Albert Steven Purnama
1,
Langgeng Agung Waskito
2,3,7,8,
Indah Mohd Amin
9 and
Nando Reza Pratama
10,11
1
Faculty of Medicine, Medical Program, Universitas Airlangga, Surabaya 60132, Indonesia
2
Department of Physiology and Medical Biochemistry, Faculty of Medicine, Universitas Airlangga, Surabaya 60132, Indonesia
3
Institute of Tropical Disease, Universitas Airlangga, Surabaya 60115, Indonesia
4
Cardiovascular and Cardiometabolic Science Research Group, Faculty of Medicine, Universitas Airlangga, Surabaya 60132, Indonesia
5
Cardiovascular and Cardiometabolic Science Research Group, Department of Cardiology and Vascular Medicine, Universitas Airlangga Hospital, Surabaya 60115, Indonesia
6
Cardiology and Vascular Medicine Department, Dr. Soetomo General Hospital, Surabaya 60286, Indonesia
7
Department of Internal Medicine, Universitas Airlangga Hospital Surabaya, Surabaya 60115, Indonesia
8
Oncology and Cancer Research Group, Faculty of Medicine, Universitas Airlangga, Surabaya 60132, Indonesia
9
Faculty of Dentistry, Universiti Teknologi MARA, Selangor 47000, Malaysia
10
Nuffield Department of Medicine, University of Oxford, Oxford OX3 7BN, UK
11
Summit Institute for Development Indonesia, Mataram 83238, Indonesia
 
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Author to whom correspondence should be addressed.
Int. J. Mol. Sci. 2026, 27(8), 3389; https://doi.org/10.3390/ijms27083389
Submission received: 11 March 2026 / Revised: 3 April 2026 / Accepted: 7 April 2026 / Published: 9 April 2026
(This article belongs to the Special Issue Emerging Biomarkers in Cardiovascular Risk Assessment and Myocardial Injury)
Review Reports Versions Notes

Abstract

Acute coronary syndrome patients undergoing percutaneous coronary intervention remain at high risk for major adverse cardiovascular events (MACE: cardiovascular mortality, non-fatal myocardial infarction, and stroke). Inflammatory–oxidative stress biomarkers are potential prognostic tools; however, the influence of sampling timing—pre-procedural versus post-procedural—remains unclear. This meta-analysis evaluated six biomarkers: sST2, GDF-15, OPG, sLOX-1, H-FABP, and Galectin-3. Pooled Hazard Ratios (HRs) for time-to-event outcomes and Standardized Mean Differences (SMDs) between event and non-event groups were synthesized using random-effects models involving 40 studies (18,933 patients). Elevated pre-procedural levels of sST2 (HR = 3.32, p < 0.0001), GDF-15 (HR = 3.00, p < 0.0001), sLOX-1 (HR = 2.61, p = 0.0023), and OPG (HR = 1.79, p = 0.0206) significantly predicted MACE. Notably, pre-PCI sST2 strongly predicted heart failure hospitalization (HR = 6.30, p < 0.0001). Additionally, pre-PCI H-FABP demonstrated a moderate significant effect on adverse outcomes (SMD = 0.67, p < 0.0001). While pre-PCI Galectin-3 was not significant, its post-procedural levels showed a large significant effect (SMD = 1.15, p < 0.0001). In conclusion, inflammatory and oxidative stress biomarkers, particularly sST2 and GDF-15, demonstrate consistent associations with adverse outcomes in ACS patients undergoing PCI, offering more reliable baseline risk stratification than post-procedural measurements.
Keywords: acute coronary syndrome; biomarkers; cardiovascular diseases; percutaneous coronary intervention; sST2; GDF-15; oxidative stress; prognosis acute coronary syndrome; biomarkers; cardiovascular diseases; percutaneous coronary intervention; sST2; GDF-15; oxidative stress; prognosis

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MDPI and ACS Style

Tambunan, J.S.M.; Wungu, C.D.K.; Susilo, H.; Santoso, A.B.Z.; Fauzana, A.A.; Hernandi, P.D.; Purnama, A.S.; Waskito, L.A.; Amin, I.M.; Pratama, N.R. The Prognostic Value of Pre-Procedural and Post-Procedural Inflammatory–Oxidative Stress Biomarkers in Acute Coronary Patients Undergoing Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis. Int. J. Mol. Sci. 2026, 27, 3389. https://doi.org/10.3390/ijms27083389

AMA Style

Tambunan JSM, Wungu CDK, Susilo H, Santoso ABZ, Fauzana AA, Hernandi PD, Purnama AS, Waskito LA, Amin IM, Pratama NR. The Prognostic Value of Pre-Procedural and Post-Procedural Inflammatory–Oxidative Stress Biomarkers in Acute Coronary Patients Undergoing Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis. International Journal of Molecular Sciences. 2026; 27(8):3389. https://doi.org/10.3390/ijms27083389

Chicago/Turabian Style

Tambunan, Jonathan Samuel Matogu, Citrawati Dyah Kencono Wungu, Hendri Susilo, Azizah Bonitha Zahrah Santoso, Anindita Azkia Fauzana, Pramudya Dhafa Hernandi, Albert Steven Purnama, Langgeng Agung Waskito, Indah Mohd Amin, and Nando Reza Pratama. 2026. "The Prognostic Value of Pre-Procedural and Post-Procedural Inflammatory–Oxidative Stress Biomarkers in Acute Coronary Patients Undergoing Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis" International Journal of Molecular Sciences 27, no. 8: 3389. https://doi.org/10.3390/ijms27083389

APA Style

Tambunan, J. S. M., Wungu, C. D. K., Susilo, H., Santoso, A. B. Z., Fauzana, A. A., Hernandi, P. D., Purnama, A. S., Waskito, L. A., Amin, I. M., & Pratama, N. R. (2026). The Prognostic Value of Pre-Procedural and Post-Procedural Inflammatory–Oxidative Stress Biomarkers in Acute Coronary Patients Undergoing Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis. International Journal of Molecular Sciences, 27(8), 3389. https://doi.org/10.3390/ijms27083389

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