Impact of Mildly Elevated Alanine Transaminase on In-Hospital Outcomes and Statin Intolerance in Elderly Patients...

Mild alanine transaminase (ALT) elevation is common in older patients with acute myocardial infarction (AMI), but its prognostic value and implications for statin therapy remain unclear.

This retrospective cohort study included 321 AMI patients aged ≥ 75 years admitted from 2014 to 2019 at Guangdong Provincial People's Hospital. Mild ALT elevation was defined as ALT between the upper limit of normal (ULN) and 3 × ULN, and significant elevation as ALT > 3 × ULN. Patients were grouped by admission ALT into normal (N, n = 201), mildly elevated (ME, n = 104), and significantly elevated (SE, n = 16). Logistic regression analyses in SPSS 26.0 and R 3.4.3 assessed the association between ALT levels and in-hospital mortality, adjusting for cardiac function, infarct size, renal function, and treatment factors.

Among survivors with elevated ALT, 87.4% achieved normalization before discharge. Statin intolerance was identified in 58 patients (18.9%) at admission and persisted in 6.7% at discharge. The ALT-ME group had significantly higher statin intolerance (36.5% vs. 2.0%, p < 0.001) and higher in-hospital mortality (18.3% vs. 6.0%, p = 0.001) compared with the ALT-N group. Logistic regression analysis demonstrated that ALT elevation was independently associated with higher in-hospital mortality (per 10 U/L ALT elevation, odds ratio 1.164, p = 0.010).

In older patients with AMI, mild elevation in ALT levels upon admission is associated with worse in-hospital outcomes, and statin intolerance is common and mostly reversible. Short-term substitutes for statins should be considered in these patients.