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.

Ru-Jie Zheng,Li-Zhu Jiang,Jian-Chao Zhang,Zeng-Lei Zhang,Lei Fan,Jin-Ying Zhang,Zhi-Yu Liu,Xiao-Ting Yue,Feng-Hua Song,Qian-Qian Guo,Yan Bai,Xin-Ya Dai,Kai Wang,Xu-Ming Yang,Meng-Die Cheng,Ying-Ying Zheng,Jun-Nan Tang

doi:10.1155/2020/4713591

Abstract

Background Alanine aminotransferase (ALT) is referred as liver transaminase and predominantly expressed by hepatocytes. Previous evidences showed that high levels of ALT were reversely associated with short- and long-term outcomes in patients with myocardial infarction. Besides, low lymphocyte has been demonstrated to be significantly correlated with adverse clinical outcomes in coronary artery disease (CAD). However, evidences about the relationship between ALT-to-lymphocyte ratio (ALR) and outcomes in CAD patients with normal liver function are limited. The aim of this study was to assess the relationship between ALR and clinical outcomes in patients with CAD. Methods This is a retrospective cohort study, and a total of 3561 patients were enrolled in Clinical Outcomes and Risk Factors of Patients with CAD after percutaneous coronary intervention (PCI), from January 2013 to December 2017. After excluding patients with liver dysfunction, we finally enrolled 2714 patients. These patients were divided into two groups according to ALR value: the lower group (ALR < 14.06, n = 1804) and the higher group (ALR ≥ 14.06, n = 910). The average follow-up time was 37.59 ± 22.24 months. Results We found that there were significant differences between the two groups in the incidence of all-cause mortality (ACM) (P < 0.001) and cardiac mortality (CM) (P=0.010). Kaplan–Meier survival analysis suggested that CAD patients with higher ALR tended to have an increased accumulated risk of ACM and CM (log rank P < 0.001 and P=0.006, respectively). Multivariate Cox regression analysis showed that ALR was an independent predictor of ACM (hazard ratio (HR) = 2.017 (95% confidence interval (CI): 1.289–3.158), P=0.002) and CM (HR = 1.862 (95% CI: 1.047–3.313), P=0.034). We did not find significant difference in the incidence of major adverse cardiovascular events (MACEs) and major adverse cardiovascular and cerebrovascular events (MACCEs) between the two groups after adjustments of confounders. Conclusion Our results indicate that ALR is an independent predictor of long-term adverse outcomes in CAD patients who underwent PCI.

Highlights

The management of coronary artery disease (CAD) has developed and improved dramatically during the past two decades, CAD is still a disease with increasing morbidity and mortality posing a major threat to human’s health [1, 2]. e pathogenesis of CAD includes several mechanisms [3], such as lipid metabolism [4, 5], inflammatory response [6, 7], and activation of the coagulation and fibrinolysis system [8]
We did not find any significant differences in respects of alcohol drinking, smoking, heart rate, hypertension, blood urea nitrogen (BUN), uric acid (UA), and high-density lipoprotein cholesterol (HDL-C)
We found that there were no significant differences in the incidence of major adverse cardiovascular events (MACEs) (11.9% vs 11.1%, P 0.530), major adverse cardiovascular and cerebrovascular events (MACCEs) (15.8% vs 14.6%, P 0.420), and stroke (4.4% vs 3.8%, P 0.513) between the two groups

Summary

Introduction

The management of coronary artery disease (CAD) has developed and improved dramatically during the past two decades, CAD is still a disease with increasing morbidity and mortality posing a major threat to human’s health [1, 2]. e pathogenesis of CAD includes several mechanisms [3], such as lipid metabolism [4, 5], inflammatory response [6, 7], and activation of the coagulation and fibrinolysis system [8]. Low lymphocyte count has been demonstrated to be significantly correlated with adverse clinical outcomes in patients with CAD [14]. Our study excludes the patients with liver dysfunction and aims to investigate the relationship between ALR and clinical outcomes in patients with CAD. Previous evidences showed that high levels of ALT were reversely associated with short- and long-term outcomes in patients with myocardial infarction. Low lymphocyte has been demonstrated to be significantly correlated with adverse clinical outcomes in coronary artery disease (CAD). Evidences about the relationship between ALT-to-lymphocyte ratio (ALR) and outcomes in CAD patients with normal liver function are limited.

Methods

Results

Conclusion