ALT-to-Lymphocyte Ratio as a Predictor of Long-Term Mortality in Patients with Normal Liver Function Presenting Coronary Artery Disease after Undergoing PCI: A Retrospective Cohort Study

Ru-Jie Zheng; Qian-Qian Guo; Jun-Nan Tang; Xu-Ming Yang; Jian-Chao Zhang; Meng-Die Cheng; Feng-Hua Song; Zhi-Yu Liu; Kai Wang; Li-Zhu Jiang; Lei Fan; Xiao-Ting Yue; Yan Bai; Xin-Ya Dai; Zeng-Lei Zhang; Ying-Ying Zheng; Jin-Ying Zhang

doi:10.1155/2020/4713591

ALT-to-Lymphocyte Ratio as a Predictor of Long-Term Mortality in Patients with Normal Liver Function Presenting Coronary Artery Disease after Undergoing PCI: A Retrospective Cohort Study

J Interv Cardiol. 2020 Apr 21:2020:4713591. doi: 10.1155/2020/4713591. eCollection 2020.

Authors

Ru-Jie Zheng^{1

2}, Qian-Qian Guo^{1

2}, Jun-Nan Tang^{1

2}, Xu-Ming Yang³, Jian-Chao Zhang^{1

2}, Meng-Die Cheng^{1

2}, Feng-Hua Song^{1

2}, Zhi-Yu Liu^{1

2}, Kai Wang^{1

2}, Li-Zhu Jiang^{1

2}, Lei Fan^{1

2}, Xiao-Ting Yue^{1

2}, Yan Bai^{1

2}, Xin-Ya Dai^{1

2}, Zeng-Lei Zhang^{1

2}, Ying-Ying Zheng^{1

2}, Jin-Ying Zhang^{1

2}

Affiliations

¹ Department of Cardiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China.
² Key Laboratory of Cardiac Injury and Repair of Henan Province, Zhengzhou, China.
³ Department of Cardiology, The First Affiliated Hospital, College of Clinical Medicine of Henan University of Science and Technology, Luoyang 471003, China.

Abstract

Background: Alanine aminotransferase (ALT) is referred as liver transaminase and predominantly expressed by hepatocytes. Previous evidences showed that high levels of ALT were reversely associated with short- and long-term outcomes in patients with myocardial infarction. Besides, low lymphocyte has been demonstrated to be significantly correlated with adverse clinical outcomes in coronary artery disease (CAD). However, evidences about the relationship between ALT-to-lymphocyte ratio (ALR) and outcomes in CAD patients with normal liver function are limited. The aim of this study was to assess the relationship between ALR and clinical outcomes in patients with CAD.

Methods: This is a retrospective cohort study, and a total of 3561 patients were enrolled in Clinical Outcomes and Risk Factors of Patients with CAD after percutaneous coronary intervention (PCI), from January 2013 to December 2017. After excluding patients with liver dysfunction, we finally enrolled 2714 patients. These patients were divided into two groups according to ALR value: the lower group (ALR < 14.06, n = 1804) and the higher group (ALR ≥ 14.06, n = 910). The average follow-up time was 37.59 ± 22.24 months.

Results: We found that there were significant differences between the two groups in the incidence of all-cause mortality (ACM) (P < 0.001) and cardiac mortality (CM) (P=0.010). Kaplan-Meier survival analysis suggested that CAD patients with higher ALR tended to have an increased accumulated risk of ACM and CM (log rank P < 0.001 and P=0.006, respectively). Multivariate Cox regression analysis showed that ALR was an independent predictor of ACM (hazard ratio (HR) = 2.017 (95% confidence interval (CI): 1.289-3.158), P=0.002) and CM (HR = 1.862 (95% CI: 1.047-3.313), P=0.034). We did not find significant difference in the incidence of major adverse cardiovascular events (MACEs) and major adverse cardiovascular and cerebrovascular events (MACCEs) between the two groups after adjustments of confounders.

Conclusion: Our results indicate that ALR is an independent predictor of long-term adverse outcomes in CAD patients who underwent PCI.

MeSH terms

Aged
Alanine Transaminase / blood*
Coronary Artery Disease / blood*
Coronary Artery Disease / mortality*
Coronary Artery Disease / surgery
Female
Humans
Kaplan-Meier Estimate
Liver
Lymphocyte Count*
Male
Middle Aged
Multivariate Analysis
Percutaneous Coronary Intervention*
Predictive Value of Tests
Proportional Hazards Models
Retrospective Studies
Risk Factors
Survival Rate

Substances

Alanine Transaminase