title: Serum transaminase determined in the emergency room predicts outcomes in patients with acute ST-segment elevation myocardial infarction who undergo primary percutaneous coronary intervention.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  The presence of HLI predicts mortality in patients with STEMI who undergo successful primary PCIs.
authors.affiliation: Cardiology Division, Department of Internal Medicine, Gil Medical Center, Gachon University, Incheon, Republic of Korea.
authors.forename: Jeonggeun
authors.initials: J
authors.lastname: Moon
authors.affiliation: Cardiology Division, Department of Internal Medicine, Gil Medical Center, Gachon University, Incheon, Republic of Korea. Electronic address: kangwch@gilhospital.com.
authors.forename: WoongChol
authors.initials: W
authors.lastname: Kang
authors.affiliation: Cardiology Division, Department of Internal Medicine, Gil Medical Center, Gachon University, Incheon, Republic of Korea.
authors.forename: Pyung Chun
authors.initials: PC
authors.lastname: Oh
authors.affiliation: Cardiology Division, Department of Internal Medicine, Gil Medical Center, Gachon University, Incheon, Republic of Korea.
authors.forename: Soon Yong
authors.initials: SY
authors.lastname: Seo
authors.affiliation: Cardiology Division, Department of Internal Medicine, Gil Medical Center, Gachon University, Incheon, Republic of Korea.
authors.forename: Kyounghoon
authors.initials: K
authors.lastname: Lee
authors.affiliation: Cardiology Division, Department of Internal Medicine, Gil Medical Center, Gachon University, Incheon, Republic of Korea.
authors.forename: Seung Hwan
authors.initials: SH
authors.lastname: Han
authors.affiliation: Cardiology Division, Department of Internal Medicine, Gil Medical Center, Gachon University, Incheon, Republic of Korea.
authors.forename: Taehoon
authors.initials: T
authors.lastname: Ahn
authors.affiliation: Cardiology Division, Department of Internal Medicine, Gil Medical Center, Gachon University, Incheon, Republic of Korea.
authors.forename: EakKyun
authors.initials: E
authors.lastname: Shin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000410:Alanine Transaminase / Q000097:blood*; D001224:Aspartic Acid / Q000097:blood; D015415:Biomarkers / Q000097:blood; D004636:Emergency Service, Hospital / Q000639:trends*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000401:mortality / Q000601:surgery*; D062645:Percutaneous Coronary Intervention / Q000401:mortality / Q000639:trends*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D001224:Aspartic Acid; D000410:Alanine Transaminase
keywords: Hypoxic liver injury; Primary PCI; STEMI; Serum transaminases