Association of serum transaminases with short- and long-term outcomes in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary interventionReportar como inadecuado




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BMC Cardiovascular Disorders

, 17:43

Coronary artery disease

Abstract

BackgroundAlanine transaminase ALT and aspartate aminotransferase AST are referred to as liver transaminases. Although used routinely in clinical practice for decades, their role as predictors of mortality has not been examined until recently. We studied the predictive value of these serum transaminases in patients with ST-segment elevation myocardial infarction STEMI treated with primary percutaneous coronary intervention PCI.

MethodsWe analyzed records of 2417 consecutive STEMI patients with no preexisting liver disease who were treated with primary PCI at the Cardiovascular Center in the First Hospital of Jilin University. The outcomes measured were all-cause mortality at the first month and at 2 years. The relationship between the baseline serum transaminase levels and primary outcome was determined.

ResultsWe found a significant correlation between elevated liver transaminases and the Killip classification P < 0.001 for ALT; P < 0.001 for AST, cardiac troponin I P = 0.002 for ALT; P < 0.001 for AST, infarct-related coronary artery P = 0.036 for ALT; P = 0.011 for AST, and pre-thrombolysis-in-myocardial-infarction pre-TIMI flow P < 0.001 for ALT and AST. The serum level of ALT and AST were high along with the increasing of the grade of Killip classification. The primary infarct-related coronary artery in patients with ALT ≥95th percentage was left anterior descending artery 56%, followed by right coronary artery 36%. The OR for all-cause mortality at 2 years for participants with ALT ≥95th percentage was 5.370 95% CI: 2.899–9.948, 7.034 95% CI: 3.718–13.307 after adjustment for age and gender and 1.051 95% CI: 0.302–3.652 after adjustment for all covariables. The OR for all-cause mortality at 2 years for participants with AST ≥95th percentage was 5.370 95% CI 2.899–9.948 and 5.699 95% CI 3.030–10.718 after adjustment for age and gender and 1.796 95% CI: 0.588–5.481 after adjustment for all covariables. ALT HR 1.004, 95% CI 1.001–1.006, P = 0.010 and AST HR 0.999, 95% CI 0.998–1.000, P = 0.030 were associated with early all-cause mortality in patients with STEMI treated with PCI but not at 2 years post-procedure, unless for AST and ALT levels ≥95th percentage. Moreover, short- and long-term outcomes were significantly worse when both AST and ALT levels ≥95th percentage P < 0.001.

ConclusionsSerum transaminases ≥95th percentage were associated with a significantly increased incidence of short- and long-term all-cause mortality.

Trial registrationRegistration number: ChiCTR-EPC-16008199, 31 March 2016.

KeywordsST-elevation myocardial infarction Serum transaminase Primary percutaneous coronary intervention AbbreviationsALPAlkaline phosphatase

ALTAlanine transaminase

ASTAspartate aminotransferase

CKMBCreatine kinase MB

GGTɤ-glutamyl transpeptidase

HDL-CHigh-density lipoprotein cholesterol

LADLeft anterior descending artery

LCXLeft circumflex coronary artery

LDL-CLow-density lipoprotein cholesterol

NT-proBNPN-terminal pro-brain natriuretic peptide

PCIPercutaneous coronary intervention

RCARight coronary artery

ROC-AUCReceiver operating characteristic area under the curve

STEMIST-segment elevation myocardial infarction

TCTotal cholesterol

TGTriglyceride

TIMIThrombolysis-in-myocardial-infarction

Tn ICardiac troponin I

Electronic supplementary materialThe online version of this article doi:10.1186-s12872-017-0485-6 contains supplementary material, which is available to authorized users.





Autor: Ming Gao - Yi Cheng - Yang Zheng - Weihua Zhang - Lin Wang - Ling Qin

Fuente: https://link.springer.com/







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