Department of Cardiology, Beijing Renhe Hospital, Beijing, China.
Graduate school of Jiamusi University, Heilongjiang, China.
Medicine (Baltimore). 2023 Aug 4;102(31):e34563. doi: 10.1097/MD.0000000000034563.
To investigate the prognostic role of the elevated aspartate and alanine aminotransferase (AST/ALT) ratio in patients with unstable angina (UA). In this observational study, all patients with UA undergoing percutaneous coronary intervention at our center from January 2019 to December 2020 were examined. Clinical presentations, laboratory parameters, and procedural characteristics were collected. The primary endpoint was a composite of major adverse cardio-cerebral events (MACCE), such as death, nonfatal myocardial infarction, nonfatal stroke, and target vessel revascularization. In total, 1123 eligible UA patients were enrolled in the present study (mean age 62.3 years; 54.5% of male). Patients in the upper tertile of the AST/ALT ratio were older, had more extensive coronary stenosis, and had poor nutritional status (P < .05). Meanwhile, the cumulative incidence of MACCE at 13 months of follow-up increased in a stepwise manner and across the tertile of the AST/ALT ratio, predominantly driven by target vessel revascularization (both log-rank P < .001). Importantly, the AST/ALT ratio was associated with MACCE in a multivariate analysis that was adjusted for potential covariates (hazard ratio 1.72, 95% confidence interval 1.48-1.99, P < .01). The optimal cutoff point of the AST/ALT ratio to predict MACCE was 1.29 (area under the curve 0.77, 95% confidence interval 0.69-0.84, P < .001), with sensitivity and specificity of 77.5% and 65.1%, respectively. The increased AST/ALT ratio, especially when above 1.29, is associated with MACCE in patients with UA undergoing percutaneous coronary intervention.
探讨天门冬氨酸和丙氨酸氨基转移酶（AST/ALT）比值升高对不稳定型心绞痛（UA）患者的预后作用。在这项观察性研究中，对 2019 年 1 月至 2020 年 12 月在我院行经皮冠状动脉介入治疗的所有 UA 患者进行了检查。收集了临床症状、实验室参数和手术特征。主要终点是主要不良心脑血管事件（MACCE）的复合结果，如死亡、非致死性心肌梗死、非致死性卒中和靶血管血运重建。本研究共纳入 1123 例符合条件的 UA 患者（平均年龄 62.3 岁；54.5%为男性）。AST/ALT 比值较高组患者年龄较大，冠状动脉狭窄程度较广，营养状况较差（P<.05）。同时，随着 AST/ALT 比值三分位的增加，13 个月随访时 MACCE 的累积发生率呈阶梯式增加，主要是由于靶血管血运重建（对数秩 P<.001）。重要的是，多变量分析显示 AST/ALT 比值与 MACCE 相关，调整了潜在混杂因素（风险比 1.72，95%置信区间 1.48-1.99，P<.01）。预测 MACCE 的 AST/ALT 比值最佳截断点为 1.29（曲线下面积 0.77，95%置信区间 0.69-0.84，P<.001），敏感性和特异性分别为 77.5%和 65.1%。UA 患者经皮冠状动脉介入治疗后，AST/ALT 比值升高，尤其是高于 1.29 时，与 MACCE 相关。
