Prognostic significance of transaminases after acute ST-elevation myocardial infarction: insights from a cardiac magnetic resonance study
Background: In patients with ST-elevation myocardial infarction (STEMI), the relationship between transaminases and myocardial damage detected by cardiac magnetic resonance (CMR) imaging is unknown and the prognostic value incompletely investigated.
Materials and methods: CMR imaging was performed in 167 STEMI patients 2.3 [1.6–3.9] days after primary percutaneous coronary intervention (PPCI). Blood samples for transaminase measurement (aspartate transaminase (AST) and alanine transaminase (ALT)) were obtained serially from day 1 to day 4 after PPCI. Patients were followed for major adverse cardiac events (MACE) for 2.7 [1.1–3.3] years.
Results: Admission and peak concentrations of AST and ALT were significantly associated with ejection fraction (p < 0.001), infarct size (p < 0.001), and the presence of microvascular obstruction (p < 0.01). Peak values of both transaminases showed a stronger correlation with CMR parameters than admission values (all p < 0.05). In Kaplan–Meier analysis, a high peak AST or high peak ALT was associated with reduced MACE-free survival (both p < 0.01), whereas admission values were not (both p > 0.05). Peak AST (hazard ratio (HR): 4.93 [1.70–14.32], p = 0.003) and peak ALT (HR: 5.67 [1.94–16.56], p = 0.002) were independent predictors of MACE after adjusting for clinical risk factors.
Conclusions: Transaminases measured in the acute phase after PPCI for STEMI are associated with systolic dysfunction, more extensive myocardial necrosis and microvascular injury with subsequent prognostic information on MACE at long-term follow-up.
Sebastian J. Reinstadler, Martin Reindl, Hans-Josef Feistritzer, Gert Klug, Agnes Mayr, Markus Kofler, Alexander Minh-Duc Tu, Luc Huybrechts, Johannes Mair, Wolfgang-Michael Franz, Bernhard Metzler, Wiener klinische Wochenschrift 21/22/2015