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.