Low ALT levels are associated with poor outcomes in acute coronary syndrome patients in the intensive cardiac care unit

Amitai Segev, Edward Itelman, Roy Beigel, Gad Segal, Fernando Chernomordik, Shlomi Matetzky, Avishay Grupper

Research output: Contribution to journalArticlepeer-review


Background: Frailty is an underrecognized and important entity that bears worse prognosis. Although low serum alanine aminotransferase (ALT) can serve as a novel marker of frailty, its use was never assessed in acute coronary syndrome (ACS) patients. Methods: A retrospective analysis of hospitalized ACS patients in the intensive cardiac care unit (ICCU)between 1/5/2011 and 1/12/2020 at a single tertiary medical center. Results: The study included 3956 patients after excluding patients with ALT >40 IU/L, cirrhosis, and missing data, followed for a medianduration of 47 months (IQR 20-77).Patients were stratified into two groups based on their first ALT measurement within the index hospitalization: low-normal ALT group (ALT ≤10 IU/L) vs. high-normal ALT group (ALT >10 IU/L). Patients with ALT≤10 IU/L were older (mean age 71 years vs. 65 years, p<0.001), presented more frequently with non-ST elevation myocardial infarction (66.4% vs. 53.2%, p< 0.001), had higher rates of comorbiditiesat baseline, and had a lower Norton score upon admission. Hospitalization length was longer in the low-normal ALT group (p< 0.001). Although the in-hospital mortality rate was similar between the groups (0.9% vs. 0.7%, p = 0.99), long-termmortality was significantly higher in the low-normal ALT group (22.7% vs. 7.9%, p< 0.001). In a multivariate regression model ALT ≤10 IU/l was associated with increased mortality (HR 2.1, 95% CI 1.46-3). Conclusions: Lower serum ALT is associated with worse outcomes in ACS patients admitted to the ICCU.

Original languageEnglish
Pages (from-to)385-390
Number of pages6
JournalJournal of Cardiology
Issue number3
StatePublished - Mar 2022
Externally publishedYes


  • Acute coronary syndrome
  • Alanine aminotransferase
  • Frailty
  • Prognosis
  • Sarcopenia


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