Pattern of liver enzyme elevations in acute ST-elevation myocardial infarction
David M Lofthus1, Susanna R Stevens, Paul W Armstrong
1Duke University Medical Center, Durham, North Carolina 27710, USA. david.lofthus@gmail.com
Insights
Liver enzyme elevations, including aspartate transaminase (AST) and alanine transaminase (ALT), are common in ST-segment elevation myocardial infarction (STEMI). These elevations independently predict worse mortality and clinical outcomes, even after accounting for creatine kinase-MB (CK-MB).
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.
Objectives:
Liver enzyme elevations occur with ST-segment elevation myocardial infarction (STEMI); however, their significance in the modern era is not well-defined. The incidence of liver enzyme elevations in STEMI, temporal trends, correlations with creatine kinase-MB (CK-MB), and associations with clinical outcomes were evaluated.
Methods:
The Complement Inhibition in Myocardial Infarction Treated with Angioplasty and Complement Inhibition in Myocardial Infarction Treated with Thrombolytics trials evaluated 1903 patients with STEMI. A core lab analyzed liver enzymes at baseline, days 1, 6, and 14, and CK-MB measured sequentially over 72 h. The GUSTO model for 30-day mortality was used to predict clinical endpoints.
Results:
A total of 1783 patients were included in the analysis. Aspartate transaminase (AST) was elevated above the upper limit of normal in 85.6% and alanine transaminase (ALT) was elevated in 48.2% of patients at baseline or day 1. CK-MB area under the curve correlated with maximum AST (r=0.727) and maximum ALT (r=0.456). Both AST and ALT elevations were independent predictors of worse outcomes in multivariable adjusted analysis, even after adjustment for CK-MB. Hazard ratios and 95% confidence intervals of AST elevation were 1.12 (1.05-1.19) for all-cause mortality, and 1.08 (1.02-1.13) for the composite endpoint of death, congestive heart failure, shock, or stroke. Hazard ratios and 95% confidence intervals of ALT elevation were 1.15 (1.04-1.27) for mortality and 1.47 (1.10-1.98) for the composite endpoint.
Conclusion:
AST and ALT elevations are common in STEMI. Both markers are correlated with CK-MB area under the curve, but independently associated with worse mortality and clinical outcomes.
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