Association of serum transaminases with short- and long-term outcomes in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention

Abstract

BackgroundAlanine transaminase (ALT) and aspartate aminotransferase (AST) are referred to as liver transaminases. Although used routinely in clinical practice for decades, their role as predictors of mortality has not been examined until recently. We studied the predictive value of these serum transaminases in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI).MethodsWe analyzed records of 2417 consecutive STEMI patients with no preexisting liver disease who were treated with primary PCI at the Cardiovascular Center in the First Hospital of Jilin University. The outcomes measured were all-cause mortality at the first month and at 2 years. The relationship between the baseline serum transaminase levels and primary outcome was determined.ResultsWe found a significant correlation between elevated liver transaminases and the Killip classification (P < 0.001 for ALT; P < 0.001 for AST), cardiac troponin I (P = 0.002 for ALT; P < 0.001 for AST), infarct-related coronary artery (P = 0.036 for ALT; P = 0.011 for AST), and pre-thrombolysis-in-myocardial-infarction (pre-TIMI) flow (P < 0.001 for ALT and AST). The serum level of ALT and AST were high along with the increasing of the grade of Killip classification. The primary infarct-related coronary artery in patients with ALT ≥95th percentage was left anterior descending artery (56%), followed by right coronary artery (36%). The OR for all-cause mortality at 2 years for participants with ALT ≥95th percentage was 5.370 (95% CI: 2.899–9.948), 7.034 (95% CI: 3.718–13.307) after adjustment for age and gender and 1.051 (95% CI: 0.302–3.652) after adjustment for all covariables. The OR for all-cause mortality at 2 years for participants with AST ≥95th percentage was 5.370 (95% CI 2.899–9.948) and 5.699 (95% CI 3.030–10.718) after adjustment for age and gender and 1.796 (95% CI: 0.588–5.481) after adjustment for all covariables. ALT (HR 1.004, 95% CI 1.001–1.006, P = 0.010) and AST (HR 0.999, 95% CI 0.998–1.000, P = 0.030) were associated with early all-cause mortality in patients with STEMI treated with PCI but not at 2 years post-procedure, unless for AST and ALT levels ≥95th percentage. Moreover, short- and long-term outcomes were significantly worse when both AST and ALT levels ≥95th percentage (P < 0.001).ConclusionsSerum transaminases ≥95th percentage were associated with a significantly increased incidence of short- and long-term all-cause mortality.Trial registrationRegistration number: ChiCTR-EPC-16008199, 31 March 2016.Electronic supplementary materialThe online version of this article (doi:10.1186/s12872-017-0485-6) contains supplementary material, which is available to authorized users.

Laboratory and instrumental parameters of patients with ischemic heart disease in dependence of gallbladder condition: correlational analysis

“…Investigation of transaminases prognostic role in 2417 patients after percutaneous coronary intervention because of myocardial infarction showed that increase of ALT level correlated with stenosis of anterior interventricular artery and RCA. Increase of ALT concentration in these patients was associated with increased mortality immediately after intervention and in the remote period [5].…”

“…Проаналізували 35 клініко-лабораторних та інструментально-діагностичних показників 98 пацієнтів із верифікованою ІХС (40 % -гострий інфаркт міокарда, 60 % -нестабільна стенокардія; 79 % чоловіків і 21 % жінок; середній вік -61,7 ± 1,6 року), яких поділено на групи залежно від стану ЖМ: інтактний (29); сладж і холестероз (13); перегини тіла (13); деформації шийки та холецистит (27); холелітіаз (11); холецистектомія в анамнезі (5), за допомогою кореляційного аналізу. Ранжування стану ЖМ здійснено на підставі того, що зміни починаються зі сладжу та холестерозу, що за умов деформацій тіла та шийки ЖМ з утрудненням відтоку жовчі та скоротливості, призводять до холелітіазу, ускладнення якого є показанням до холецистектомії.…”

Nomogram Containing Simple Routine Clinical and Biochemical Parameters Can Predict Pathological Ventricular Remodeling in STEMI Patients

“…Perhaps the biggest surprise in our nomogram is better correlation of pathological ventricular remodeling present 1 year after the myocardial infarction with AST than with CK (when CK is included instead of AST predictive value drops slighty, to approximately 88%). This can be attributed to statistical "glitch" due to low patient sample, but we believe that, since AST proved to be elevated after ischemic cell death of several other tissues, including kidney, skeletal muscle and brain, better correlation of AST is due to it being a marker of ishaemic end organ damage in acute coronary syndrom and not dominantly a marker of myocardial lesion (8)(9)(10)(11)(12). It is also noted that myocardial infarction affecting left anterior descending coronary artery is associated with the highest risk of adverse clinical outcomes because of the large amount of myocardial territory supplied by the LAD compared to other coronary arteries (13).…”

ALT-to-Lymphocyte Ratio as a Predictor of Long-Term Mortality in Patients with Normal Liver Function Presenting Coronary Artery Disease after Undergoing PCI: A Retrospective Cohort Study

“…erefore, ALT represents a specific biomarker for hepatocellular injury. Previous evidences showed that high levels of ALT were reversely associated with short-and longterm outcomes in patients with myocardial infarction [9,10]. Several other studies elucidated that elevated ALT was also associated with a higher prevalence of triple vessel CAD [11].…”