Predictive value of elevated alanine aminotransferase for in-hospital mortality in patients with acute myocardial infarction

Abstract

Background and aims Liver enzymes, including alanine aminotransferase (ALT) and aspartate aminotransferase (AST), are markers of hepatic dysfunction and fatty liver disease. Although ALT and AST have been suggested as risk factors for cardiovascular disease, their role as predictors of mortality after acute myocardial infarction (AMI) has not been established. The objective of this study was to investigate the predictive value of ALT and AST for mortality in patients with AMI. Methods We analyzed records of 712 patients with AMI and no known liver disease treated at the Department of Cardiovascular Center in the First Hospital of Jilin University. The primary outcome was all-cause in-hospital mortality. Relationships between primary outcome and various risk factors, including serum transaminase levels, were assessed using multivariate logistic regression analysis. Results Age (P < 0.001), hypertension (P = 0.034), prior myocardial infarction (P < 0.001), AST (P < 0.001), ALT (P < 0.001), creatinine (P = 0.007), blood urea nitrogen (P = 0.006), and troponin I (P < 0.001) differed significantly between ST-segment elevation myocardial infarction (STEMI) and non-STEMI. The following factors were associated with an increased risk of in-hospital all-cause mortality in patients with AMI: ALT ≥ 2ULN (adjusted odds ratio [AOR] 2.240 [95% confidence interval (CI), 1.331–3.771]; P = 0.002); age ≥ 65 year (AOR 4.320 [95% CI 2.687–6.947]; P < 0.001); increased fasting plasma glucose (FPG) (AOR 2.319 [95% CI 1.564–3.438]; P < 0.001); elevated D-dimer (AOR 2.117 [95% CI 1.407–3.184]; P < 0.001); elevated fibrinogen (AOR 1.601 [95% CI 1.077–2.380]; P = 0.20); and reduced estimated glomerular filtration rate (eGFR) (AOR 2.279 [95% CI 1.519–3.419]; P < 0.001). Conclusions Our findings demonstrated that elevated ALT was independently associated with increased in-hospital all-cause mortality in patients with AMI. Other risk factors were increased age, FPG, D-dimer, and fibrinogen and decreased eGFR.

From Classic to Modern Prognostic Biomarkers in Patients with Acute Myocardial Infarction

“…In a retrospective center study conducted on 569 AMI patients, AST was found to be a predictor factor for cardiac death and MACEs (AMI, unstable angina, TLR or another segment or coronary vessel, stroke and saphenous vein aortocoronary bypass grafting) at 6 years of follow-up, its value being significantly correlated with troponin and myoglobin [ 136 ]. Li et al [ 137 ] reported that, in AMI patients, increased AST was not an independent predictor for in-hospital mortality, in contrast to alanine aminotransferase (ALT), which was found to be a marker of elevated risk of early death, together with older age; increased d-dimers, fibrinogen or fasting plasma glucose; and decreased eGFR. A prospective study that assessed the association between AST levels and all-cause mortality in STEMI patients determined a predictive value for levels greater than 492 U/L for all-cause mortality at short- and long-term follow-up, with these levels being correlated with Killip classification, pre-TIMI flow, cTnI and infarct-related coronary artery [ 135 ].…”

Lessons learned from the management of a case of acute synchronous cardio cerebral infarction in a resource-poor setting

“…Elevation of the liver zymes is common in STEMI (30), possibly due to ischemia following a reduced cardiac output (31). Elevated liver enzyme levels in patients with the acute coronary syndrome is a poor prognostic factor (32). In the setting of myocardial infarction, congestive heart failure should always be considered as a possible cause of acute liver failure (33).…”

High Aspartate Aminotransferase/Alanine Aminotransferase Ratio is the Conventional Biochemical Biomarker that is Most Closely Associated with All-Cause Mortality in Older People

“…After the conclusion of a contract between Yamato City and Kanagawa University of Human Services, we received the data, which comprised clinical parameters, nursing care level, and mortality, but not the cause of death. The study protocol was approved by the ethics committee of Kanagawa University of Human Services (Approval number [17][18][19][20][21][22][23][24][25][26] and the study conformed with the principles of the Declaration of Helsinki. The requirement for informed consent was waived because it was a retrospective study of anonymized data.…”

“…During the past two decades, many studies have shown that low serum alanine aminotransferase (ALT) activity and high aspartate transaminase (AST)/ALT ratio are associated with high mortality in older people [1][2][3][4][5][6][7][8][9][10][11][12][13]. However, the mechanisms involved remain to be conclusively established [14][15][16][17]. Some previous studies have also shown that high AST activity is associated with mortality [18,19].…”

“…Institutional Review Board Statement: The study was conducted according to the principles of the Declaration of Helsinki and approved by the Institutional Review Board of the Ethics Committee of Kanagawa University of Human Services (17)(18)(19)(20)(21)(22)(23)(24)(25)(26).…”