Predictive value of elevated alanine aminotransferase for in-hospital mortality in patients with acute myocardial infarction

Background and aims Liver enzymes, including alanine aminotransferase (ALT) and aspartate aminotransferase (AST), are markers of hepatic dysfunction and fatty liver disease. Although ALT and AST have been suggested as risk factors for cardiovascular disease, their role as predictors of mortality after acute myocardial infarction (AMI) has not been established. The objective of this study was to investigate the predictive value of ALT and AST for mortality in patients with AMI. Methods We analyzed records of 712 patients with AMI and no known liver disease treated at the Department of Cardiovascular Center in the First Hospital of Jilin University. The primary outcome was all-cause in-hospital mortality. Relationships between primary outcome and various risk factors, including serum transaminase levels, were assessed using multivariate logistic regression analysis. Results Age (P < 0.001), hypertension (P = 0.034), prior myocardial infarction (P < 0.001), AST (P < 0.001), ALT (P < 0.001), creatinine (P = 0.007), blood urea nitrogen (P = 0.006), and troponin I (P < 0.001) differed significantly between ST-segment elevation myocardial infarction (STEMI) and non-STEMI. The following factors were associated with an increased risk of in-hospital all-cause mortality in patients with AMI: ALT >= 2ULN (adjusted odds ratio [AOR] 2.240 [95% confidence interval (CI), 1.331-3.771]; P = 0.002); age >= 65 year (AOR 4.320 [95% CI 2.687-6.947]; P < 0.001); increased fasting plasma glucose (FPG) (AOR 2.319 [95% CI 1.564-3.438]; P < 0.001); elevated D-dimer (AOR 2.117 [95% CI 1.407-3.184]; P < 0.001); elevated fibrinogen (AOR 1.601 [95% CI 1.077-2.380]; P = 0.20); and reduced estimated glomerular filtration rate (eGFR) (AOR 2.279 [95% CI 1.519-3.419]; P < 0.001). Conclusions Our findings demonstrated that elevated ALT was independently associated with increased in-hospital all-cause mortality in patients with AMI. Other risk factors were increased age, FPG, D-dimer, and fibrinogen and decreased eGFR.

Automated summary

This study investigated the predictive value of ALT and AST for mortality in patients with AMI and found that elevated ALT was independently associated with increased in-hospital all-cause mortality. Other risk factors included increased age, fasting plasma glucose, D-dimer, fibrinogen, and decreased estimated glomerular filtration rate (eGFR).