Pattern of liver enzyme elevations in acute ST-elevation myocardial infarction

Area of Science:

• Cardiology
• Biochemistry
• Clinical Medicine

Background:

• Liver enzyme elevations are observed in ST-segment elevation myocardial infarction (STEMI).
• The clinical significance of these elevations in the current era of STEMI treatment is not well-defined.
• Understanding these markers can provide insights into myocardial injury and patient prognosis.

Purpose of the Study:

• To determine the incidence and temporal trends of liver enzyme elevations in STEMI patients.
• To evaluate the correlation between liver enzymes (AST, ALT) and creatine kinase-MB (CK-MB).
• To assess the association of liver enzyme elevations with clinical outcomes in STEMI.

Main Methods:

• Analysis of data from the Complement Inhibition in Myocardial Infarction Treated with Angioplasty and Complement Inhibition in Myocardial Infarction Treated with Thrombolytics trials, including 1903 STEMI patients.
• Sequential measurement of liver enzymes (AST, ALT) and CK-MB over 72 hours.
• Utilized the GUSTO model for predicting 30-day mortality and clinical endpoints.

Main Results:

• Elevated aspartate transaminase (AST) and alanine transaminase (ALT) were observed in 85.6% and 48.2% of patients, respectively, at baseline or day 1.
• CK-MB area under the curve showed significant correlation with maximum AST (r=0.727) and maximum ALT (r=0.456).
• Both AST and ALT elevations were independent predictors of worse outcomes, including mortality and a composite endpoint, even after adjusting for CK-MB.

Conclusions:

• Aspartate transaminase (AST) and alanine transaminase (ALT) elevations are frequent in ST-segment elevation myocardial infarction (STEMI).
• These liver enzymes correlate with myocardial injury markers like CK-MB.
• Importantly, AST and ALT elevations independently predict poorer mortality and clinical outcomes in STEMI patients.