Validation of the Value of Hypoxic Liver Injury at Admission for Predicting Hypoxic Hepatitis and Mortality during Hospitalization in ST Elevation Myocardial Infarction Patients undergoing Primary Percutaneous Coronary Intervention

초록

Objectives We sought to determine the value of hypoxic liver injury (HLI) at emergency room (ER) for predicting hypoxic hepatitis (HH) and in-hospital mortality in ST elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI). Methods A total of 1537 consecutive patients (79.2% male, mean age 60.5±13.2 years) with STEMI underwent primary PCI were analyzed. HLI at ER was defined as ≥2-fold increase of serum aspartate transaminase (AST) above upper normal limit at admission. HH was defined as ≥20-fold increase of peak AST above upper normal limit. Patients were divided into four groups according to HLI and HH states (group 1; no HLI and HH, group 2; HLI, but no HH, group 3; no HLI, but HH, group 4; both HLI and HH). Results The overall incidences of HLI at ER and HH in STEMI patients during hospitalization were 22% and 2%, respectively. The in-hospital mortality rates were 3.1%, 11.8%, 28.6%, and 47.1% for group 1, 2, 3, and 4, respectively. Patients with HLI and/or HH had lower blood pressure, higher heart rate, worse Killip class, more cardiac biomarker elevation, lower LVEF, more frequent right coronary artery site of infarct related artery, and more requirement for IABP usage. Multivariate logistic regression analysis revealed that HLI at ER was an independent predictor of HH, even after adjustment for Killip classification, heart rate, and left ventricular ejection fraction (LVEF) (HR 2.572, 95%CI 1.166-5.675, p=0.019). In terms of in-hospital mortality, the predictive value of HLI at ER and HH during hospitalization in STEMI patients undergone primary PCI were comparable (AUC 0.701 for HLI at ER and AUC 0.674 for HH). Conclusions HLI at ER is a novel predictor for the development of HH and mortality during hospitalization in STEMI patients undergoing primary PCI.