Deutsches Herzzentrum München, Technische Universität, Munich, Germany.
Institut für Laboratoriumsmedizin, Deutsches Herzzentrum München, Technische Universität, Munich, Germany.
Clin Chim Acta. 2019 Sep;496:55-61. doi: 10.1016/j.cca.2019.06.021. Epub 2019 Jun 27.
Data regarding the association between alanine aminotransferase (ALT) and prognosis of patients with coronary artery disease (CAD) are limited. The aim of this study was to assess the association of ALT with the prognosis of patients with CAD.
The study included 9523 patients with angiography-proven CAD who underwent percutaneous coronary intervention. Baseline ALT activity measurements were available for analysis in all patients. The primary outcome was 3-year cardiac mortality.
Patients were divided into three groups: a group with ALT within the 1st tertile (ALT 2.0 U/L to ≤17.0 U/L; n = 3276 patients), a group with ALT within the 2nd tertile (ALT >17.0 U/L to ≤26.0 U/L; n = 3075 patients) and a group with ALT within 3rd tertile (>26 U/L to ≤50.0 U/L; n = 3172 patients). Cardiac death (primary outcome) occurred in 441 patients: 201 (7.1%), 126 (4.7%) and 114 (4.0%) of these occurring in patients in the 1st, 2nd and 3rd ALT tertiles, respectively (with percentages representing Kaplan-Meier estimates of 3-year cardiac mortality); adjusted hazard ratio = 1.43, 95% confidence interval 1.11 to 1.85, P = 0.006 calculated for 1 unit decrement in the logarithmic scale of ALT. The multivariable model for cardiac mortality with baseline variables without ALT had a C-statistic of 0.827 [0.801-0.853], P < 0.001, which increased to 0.832 [0.806-0.857], P < 0.001 after incorporation of ALT (P = 0.020).
In patients with CAD, ALT was inversely and independently associated with the risk of 3-year cardiac mortality. Low ALT may reflect cardiovascular risk that is poorly mediated by traditional cardiovascular risk factors.
有关丙氨酸氨基转移酶（ALT）与冠状动脉疾病（CAD）患者预后之间的关系的数据有限。本研究旨在评估 ALT 与 CAD 患者预后的关系。
本研究纳入了 9523 名经血管造影证实的 CAD 患者，他们接受了经皮冠状动脉介入治疗。所有患者均进行了基线 ALT 活性测量分析。主要终点为 3 年心脏死亡率。
患者被分为三组：一组 ALT 在第 1 个三分位（ALT 2.0U/L 至≤17.0U/L；n=3276 例），一组 ALT 在第 2 个三分位（ALT>17.0U/L 至≤26.0U/L；n=3075 例），一组 ALT 在第 3 个三分位（ALT>26.0U/L 至≤50.0U/L；n=3172 例）。共有 441 例患者发生心脏死亡（主要终点）：第 1、2 和 3 个 ALT 三分位组分别有 201 例（7.1%）、126 例（4.7%）和 114 例（4.0%）发生心脏死亡（分别代表 Kaplan-Meier 估计的 3 年心脏死亡率百分比）；调整后的危险比为 1.43，95%置信区间为 1.11 至 1.85，P=0.006，计算为 ALT 对数刻度下降 1 个单位。无 ALT 的基线变量的心脏死亡率多变量模型的 C 统计量为 0.827[0.801-0.853]，P<0.001，纳入 ALT 后增加至 0.832[0.806-0.857]，P<0.001（P=0.020）。
在 CAD 患者中，ALT 与 3 年心脏死亡率的风险呈负相关且独立相关。低 ALT 可能反映了传统心血管危险因素介导不良的心血管风险。
