Prognostic values of admission transaminases in ST-elevation myocardial infarction submitted to primary angioplasty
Chiara Lazzeri, Serafina Valente, Roberto Tarquini, Marco Chiostri, Claudio Picariello, Gian Franco Gensini
Med Sci Monit 2010; 16(12): CR567-574
Background: Recent evidence has documented a relation between elevated transaminases and atherosclerosis, independent of classic risk factors, including the metabolic syndrome. No data are thus far available on the prognostic role of transaminases in acute myocardial infarction.
Material/Methods: We assessed whether admission transaminases (alanine aminotransferase – ALT and aspartate aminotransferase – AST) hold a prognostic role for in-intensive Cardiac Care Unit (ICCU) mortality and complications (acute pulmonary edema and/or arrhythmias) in 1000 consecutive patients with ST-elevation myocardial infarction submitted to mechanical revascularization.
Results: ALT and AST were independent predictors for in-ICCU mortality and for in-ICCU complications (when adjusted for age, left ventricular ejection fraction and sex) in the overall population, in diabetic patients but not in non-diabetic ones. ALT showed a significant correlation with NT-pro-BNP, Tn I, uric acid and leukocyte count in the overall population and in non-diabetic STEMI patients. AST showed a significant correlation with Tn I, uric acid and leukocyte count in the overall population and in non-diabetic patients. In diabetic patients, ALT and AST were significantly correlated only with peak Tn I.
Conclusions: In 1000 consecutive STEMI patients submitted to mechanical revascularization, admission ALT and AST were independent predictors for in-ICCU mortality and complications in non-diabetic patients, being strictly related to infarct size (as indicated by peak Tn I), the degree of inflammatory activation (as inferred by leukocytes) and prognostic markers (NT-pro-BNP and uric acid). In diabetic STEMI patients, only ALT results were an independent predictor for in-hospital mortality and complications, being associated with peak Tn I.
Keywords: Pulmonary Edema - etiology, Peptide Fragments - diagnostic use, Natriuretic Peptide, Brain - diagnostic use, Myocardial Infarction - therapy, Leukocyte Count, Italy, Humans, Diabetes Mellitus - blood, Aspartate Aminotransferases - blood, Arrhythmias, Cardiac - etiology, Angioplasty, Alanine Transaminase - blood, Age Factors, Sex Factors, Statistics, Nonparametric, Uric Acid - diagnostic use