ArticleCardiology journal2023
Elevated serum transaminases in patients with acute coronary syndromes: Do we need a revision of exclusion criteria for clinical trials?
Article in Cardiology journal, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers.
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Who cites it
17 citing papers in PubMed, 18 citations in OpenAlex.
- Beyond BMI: body composition phenotypes and their systemic inflammatory profiles in patients with osteoporotic vertebral compression fracture.BMC musculoskeletal disorders · 2026Article
- Clinical Determinants and Prognostic Significance of Circulating Angiopoietin-Like Protein 3 Levels in Patients With Chronic Coronary Syndrome.Circulation reports · 2026Article
- Clinical efficacy, safety, and predictors of treatment response to SGLT2 versus DPP-4 inhibitors in type 2 diabetes: a retrospective comparative study.Frontiers in endocrinology · 2026Article
- Liver Function Abnormalities in Acute Heart Failure: A State-of-the-art Review from an International Expert Group.Cardiac failure review · 2026Review
- Unveiling the Antimalarial Potential of Leaf Extracts ofJournal of tropical medicine · 2026Article
- DeRitis ratio is associated with unfavorable prognosis in ACS patients.Frontiers in cardiovascular medicine · 2026Article
- Thoracoabdominal Normothermic Regional Perfusion: Real-world Experience and Outcomes of DCD Liver Transplantation.Transplantation direct · 2025Article
- Impact of Mildly Elevated Alanine Transaminase on In-Hospital Outcomes and Statin Intolerance in Elderly Patients With Acute Myocardial Infarction: A Retrospective Cohort Study.Cardiology research and practice · 2025Article
- Clinical utility of the Fibrosis-4 index for predicting mortality in patients with heart failure with or without metabolic dysfunction-associated steatotic liver disease: a prospective cohort study.The Lancet regional health. Europe · 2025Article
- Acute Coronary Syndrome After Aneurysmal Subarachnoid Hemorrhage: Incidence, Risk Factors and Impact on the Outcome.Medicina (Kaunas, Lithuania) · 2024Article
- Article
- Comparison of Diagnostic Parameters of Acute Coronary Syndromes in Patients with and without Cancer: A Multifactorial Analysis.Current oncology (Toronto, Ont.) · 2024Article
- Identification of predictors for the comprehensive clinical risk and severity of coronary lesions of acute coronary syndrome.Frontiers in cardiovascular medicine · 2023Article
- A High De Ritis Ratio is Associated with Mortality in Adult Trauma Patients.Risk management and healthcare policy · 2023Article
- Delta De Ritis Ratio Is Associated with Worse Mortality Outcomes in Adult Trauma Patients with Moderate-to-Severe Traumatic Brain Injuries.Diagnostics (Basel, Switzerland) · 2022Article
- Using Second Measurement of De Ritis Ratio to Improve Mortality Prediction in Adult Trauma Patients in Intensive Care Unit.Diagnostics (Basel, Switzerland) · 2022Article
- SARS-COV-ATE risk assessment model for arterial thromboembolism in COVID-19.Scientific reports · 2022Article
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Authors and funding
10 authors at 4 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundElevations of hepatic transaminase (serum alanine transaminase [ALT] and serum aspartate aminotransferase [AST]) levels in patients with acute coronary syndrome (ACS), although transient, may result in exclusions from clinical efficacy trials due to suspected liver disease. The aim of this study was to evaluate the concentrations of serum transaminases in ACS and relate these to currently accepted AST/ALT exclusion criteria from clinical trials.
methodsOne hundred consecutive patients with ACS were prospectively examined. Blood samples for AST, ALT, total bilirubin and troponin I concentration were obtained at the time of admission and after 6, 12 and 24 hours.
resultsEighty percent of patients had elevated AST, and 47% ALT; 43% of patients characterized AST concentration > 3 × upper limit of normal (ULN) in at least one measurement, while 8% of patients presented ALT concentration > 3 × ULN. AST presented higher concentrations when compared to ALT, resulting in a high De-Ritis ratio at every time point. No significant or high correlations were found between the concentrations of serum transaminases, De-Ritis ratio and troponin I. Two different cut-off values of troponin I were adopted to define the amount of infarcted myocardium that distinguished 28-31% of individuals with "large infarction". Among these patients, approximately 93% presented AST concentrations > 3 × ULN.
conclusionsHepatic transaminases are often elevated in ACS, with the majority of patients with more extensive myocardial injury presenting high concentrations of AST. In the setting of ACS, current transaminase thresholds for liver dysfunction used in clinical trials may lead to excessive and inadequate exclusions of patients with larger infarcts from such trials.
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