Impact of Mildly Elevated Alanine Transaminase on In-Hospital Outcomes and Statin Intolerance in Elderly Patients With Acute Myocardial Infarction: A Retrospective Cohort Study.
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引用次数: 0
Abstract
Background: 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.
Methods: 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.
Results: 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).
Conclusion: 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.
背景：轻度谷丙转氨酶（ALT）升高在老年急性心肌梗死（AMI）患者中很常见，但其预后价值和他汀类药物治疗的意义尚不清楚。方法：回顾性队列研究纳入广东省人民医院2014 - 2019年收治的321例年龄≥75岁的AMI患者。轻度ALT升高定义为ALT在正常（ULN）上限和3倍ULN之间，显著升高定义为ALT低于3倍ULN。根据入院时ALT分为正常（N = 201）、轻度升高（ME, N = 104）和显著升高（SE, N = 16）。在spss26.0和r3.4.3中进行Logistic回归分析，评估ALT水平与住院死亡率之间的关系，调整心功能、梗死面积、肾功能和治疗因素。结果：在ALT升高的幸存者中，87.4%在出院前恢复正常。58例患者（18.9%）入院时发现他汀类药物不耐受，出院时持续6.7%。与ALT-N组相比，ALT-ME组有更高的他汀类药物不耐受（36.5% vs. 2.0%, p < 0.001）和更高的住院死亡率（18.3% vs. 6.0%, p = 0.001）。Logistic回归分析显示，ALT升高与住院死亡率升高独立相关（每10 U/L ALT升高，优势比1.164,p = 0.010）。结论：在老年AMI患者中，入院时ALT水平轻度升高与较差的住院预后相关，他汀类药物不耐受是常见的，且大多数是可逆的。这些患者应考虑使用他汀类药物的短期替代品。
期刊介绍：
Cardiology Research and Practice is a peer-reviewed, Open Access journal that publishes original research articles, review articles, and clinical studies that focus on the diagnosis and treatment of cardiovascular disease. The journal welcomes submissions related to systemic hypertension, arrhythmia, congestive heart failure, valvular heart disease, vascular disease, congenital heart disease, and cardiomyopathy.
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