Moon Jeonggeun, Kang WoongChol, Oh Pyung Chun, Seo Soon Yong, Lee Kyounghoon, Han Seung Hwan, Ahn Taehoon, Shin EakKyun
Cardiology Division, Department of Internal Medicine, Gil Medical Center, Gachon University, Incheon, Republic of Korea.
Cardiology Division, Department of Internal Medicine, Gil Medical Center, Gachon University, Incheon, Republic of Korea.
Int J Cardiol. 2014 Dec 15;177(2):442-7. doi: 10.1016/j.ijcard.2014.09.002. Epub 2014 Oct 16.
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.
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.
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).
The presence of HLI predicts mortality in patients with STEMI who undergo successful primary PCIs.
急性ST段抬高型心肌梗死（STEMI）患者常出现血清天冬氨酸氨基转移酶和丙氨酸氨基转移酶（AST和ALT）升高，这种情况被归因于肝脏灌注不足。我们评估了STEMI患者中缺氧性肝损伤（HLI）的患病率及其对预后的影响。
纳入接受直接经皮冠状动脉介入治疗（PCI）且无既往肝脏疾病的STEMI患者。就诊时进行血液检查，并在首次PCI后进行经胸超声心动图检查。我们查阅病历并通过电话联系患者家属以评估预后。
在456例患者（年龄60±13岁，男性370例）中，31例（7%）在随访期间（时长：754±540天）死亡。这些患者年龄更大（72±10岁对59±13岁），就诊时AST（179±224对64±103 U/L）、ALT（56±79对35±33 U/L）、血尿素氮（25±15对17±7 mg/dL）、尿酸（6.9±2.9对5.8±1.6 mg/dL）、肌酸激酶心肌型同工酶（76±104对41±79 ng/mL）、肌钙蛋白I（19.9±23.0对10.8±19.1 ng/mL）更高，白蛋白更低（4.0±0.5对4.2±0.4 g/dL）（所有p<0.05）。特别是，AST独立预测全因死亡率（每升高10 U/L，风险比：1.06，95%置信区间：1.02 - 1.10，p = 0.007），而心脏标志物则不能。HLI（AST或ALT高于正常上限2倍以上）与左心室射血分数降低密切相关（β = -0.12，p = 0.03），患有该病症的患者（n = 100 [20%]）的生存率低于其他患者（对数秩检验，p = 0.005）。
HLI的存在可预测成功接受直接PCI的STEMI患者的死亡率。
