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

doi:10.1016/j.ijcard.2014.09.002

International Journal of Cardiology

Volume 177, Issue 2, 15 December 2014, Pages 442-447

https://doi.org/10.1016/j.ijcard.2014.09.002 Get rights and content

Highlights

•
HLI diagnosed in the ER is common and closely correlated with LV systolic dysfunction in patients with STEMI
•
serum AST level determined at ER predicts mortality, and
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patients with HLI have higher mortality rate and more frequent MACE after PCI. Based on these results, we suggest that HLI detected on the first blood test performed in the ER is strongly associated with systolic dysfunction and might serve as an early prognosticator apparently superior to other blood test parameters.

Abstract

Background

Elevated 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.

Methods

Patients 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.

Results

Of 456 patients (age 60 ± 13 years, 370 males), 31 patients (7%) died during follow-up (duration: 754 ± 540 days). Those patients were older (72 ± 10 vs. 59 ± 13 years), had higher AST (179 ± 224 vs. 64 ± 103 U/L), ALT (56 ± 79 vs. 35 ± 33 U/L), blood urea nitrogen (25 ± 15 vs. 17 ± 7 mg/dL), uric acid (6.9 ± 2.9 vs. 5.8 ± 1.6 mg/dL), creatine kinase-myocardial band isoenzyme (76 ± 104 vs. 41 ± 79 ng/mL), troponin I (19.9 ± 23.0 vs. 10.8 ± 19.1 ng/mL), and lower albumin (4.0 ± 0.5 vs. 4.2 ± 0.4 g/dL) at the time of presentation (p < 0.05 for all). Particularly, AST independently predicted all-cause mortality (per 10 U/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).

Conclusion

The presence of HLI predicts mortality in patients with STEMI who undergo successful primary PCIs.

Section snippets

Background

Despite recent advances in techniques and improved outcomes of percutaneous coronary intervention (PCI) [1], [2], patients with acute ST-segment elevation myocardial infarction (STEMI) are still at increased risk for major adverse cardiovascular events (MACE), including mortality [3], even after a timely revascularization [4], [5]. Therefore, early risk stratification at the time of presentation is of clinical importance.

Owing to the dual blood supply from the portal vein and the hepatic

Study population

This retrospective study was approved by the institutional ethics committee of the Gil Medical Center and complies with the Declaration of Helsinki (6th revision). We used a single center registry data of STEMI; patients who were diagnosed with STEMI in the ER of our institution, underwent primary PCI and attained complete revascularization between 2007 and 2013 were enrolled. Patients with prior history of coronary artery disease, cardiomyopathy, more than mild valvular heart disease, and

Baseline characteristics and intergroup comparison

Overall monitoring period was 754 ± 540 days (median: 720 days, range: 0–2124 days). In Mortality (+) group, time to death was 199 ± 397 days (median: 12 days, range: 0–1439 days). In addition, 53 patients experienced MACE (time to MACE: 239 ± 402 days [median: 41 days, range: 0–1531 days]). Table 1 shows the baseline characteristics determined in the ER and intergroup comparison between Mortality (+) and Mortality (−) groups. Age of our cohort was 60 ± 13 years and study patients were predominantly male.

Principal findings

The core findings of the current study are (1) HLI diagnosed in the ER is common (22%) and closely correlated with post-PCI LV systolic dysfunction in patients with STEMI, (2) serum AST level determined at the time of presentation predicts future mortality after successful primary PCI, and (3) patients with HLI have higher mortality rate and more frequent occurrence of MACE after the index procedure. To the best of our knowledge, this study is the first to report on the prevalence, potential

Limitation

First, the current investigation was based on data from a single center; therefore, our study group is not representative of all STEMI patients undergoing PCI. However, in our opinion, that drawback might also be an advantage of this study, because overall patient-management strategy, including PCI technique and device used during the procedure might be relatively more homogenous than that of a multicenter study. Second, AST is present not only in the liver but also in other organs, including

Funding sources

This work was supported by the Gachon University Gil Medical Center (Grant number: 2013–10 and 2013–46) and by the Boryung Pharmaceutical Company, Republic of Korea.

Conflict of interest

The authors report no relationships that could be construed as a conflict of interest.

Acknowledgement

We would like to thank Kwang-pil Ko for providing the statistical support.

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

Highlights

Abstract

Background

Methods

Results

Conclusion

Section snippets

Background

Study population

Baseline characteristics and intergroup comparison

Principal findings

Limitation

Funding sources

Conflict of interest

Acknowledgement

J Am Coll Cardiol

Lancet

J Am Coll Cardiol

Clin Liver Dis

Int J Cardiol

Mayo Clin Proc

Am Heart J

Am J Med

Clin Liver Dis

JACC Cardiovasc Interv