Serum transaminase determined in the emergency room predicts outcomes in patients with acute ST-segment elevation myocardial infarction who undergo primary percutaneous coronary intervention

Abstract

BackgroundElevated serum aspartate and alanine aminotransferase (AST and ALT) are often observed in patients with acute ST-segment elevation myocardial infarction (STEMI) and the condition is ascribed to liver hypoperfusion. We evaluated the prevalence and prognostic implication of hypoxic liver injury (HLI) in STEMI. MethodsPatients with STEMI and no preexisting liver disease who underwent primary percutaneous coronary intervention (PCI) were enrolled. A blood test was performed at the time of presentation and transthoracic echocardiography was performed after the index PCI. We reviewed medical records and contacted families of the patients by telephone to assess outcomes. ResultsOf 456 patients (age 60±13years, 370 males), 31 patients (7%) died during follow-up (duration: 754±540days). Those patients were older (72±10 vs. 59±13years), had higher AST (179±224 vs. 64±103U/L), ALT (56±79 vs. 35±33U/L), blood urea nitrogen (25±15 vs. 17±7mg/dL), uric acid (6.9±2.9 vs. 5.8±1.6mg/dL), creatine kinase-myocardial band isoenzyme (76±104 vs. 41±79ng/mL), troponin I (19.9±23.0 vs. 10.8±19.1ng/mL), and lower albumin (4.0±0.5 vs. 4.2±0.4g/dL) at the time of presentation (p<0.05 for all). Particularly, AST independently predicted all-cause mortality (per 10U/L increase, hazard ratio: 1.06, 95% confidence interval: 1.02–1.10, p=0.007), whereas cardiac markers did not. HLI (>2-fold elevation of AST or ALT upper normal limits) showed close correlation with reduced left ventricular ejection fraction (β=−0.12, p=0.03) and patients with the condition (n=100 [20%]) had poorer survival than the others (Log-Rank, p=0.005). ConclusionThe presence of HLI predicts mortality in patients with STEMI who undergo successful primary PCIs.