Hepatocardial syndrome in patients after ST-segment elevation myocardial infarction. GEFEST study

Objective. To investigate the clinical and laboratory changes, specifically focusing on liver function tests, echocardiographic parameters, as well as cognitive and emotional status, and to assess the incidence of cardiovascular events over a period of 12 months in elderly patients diagnosed with hepatocardial syndrome after ST-elevation myocardial infarction (STEMI), in the settings of standard cardiac therapy. Materials and methods. A prospective cohort comparative study was conducted, involving 537 patients aged 60 years or older (median age 68 [64; 73] years), who were evaluated no later than 6 months after a STEMI event. Two comparable groups were established through stratified selection based on sex, age, left ventricular ejection fraction (LVEF), and the grade of hepatic dysfunction: the main study group (n=269) and the control group (n=268). Patients in the main study group received ademetionine in addition to standard cardiac therapy, while those in the control group received standard therapy only. The primary endpoints included changes in alanine aminotransferase (ALAT), gamma-glutamyl transpeptidase (GGTP), and albumin levels at 6 months. Secondary endpoints included changes in LVEF, validated questionnaires scores (Montreal Cognitive Assessment Scale, Hospital Anxiety and Depression Scale, and Multidimensional Assessment of Fatigue), and the frequency of recurrent myocardial infarction, stroke, and cardiovascular mortality within 12 months. Statistical analyses were performed using the t-test, Mann—Whitney test, Pearson’s χ² test, and Bonferroni-corrected Cox regression for primary outcomes (p<0.0167). Results. In the main study group, a significant decrease in ALT levels was observed at 6 months, with a reduction of 41.8% (from 56.8±16.4 to 33.1±11.6 U/L), and a decrease in GGTP by 49.6% (from 78.4±24.6 to 39.5±14.8 U/L); albumin levels increased by 17.2% (from 34.2±4.6 to 40.1±5.0 g/L). All changes were statistically significant (p<0.001). In contrast, changes in the control group were minimal (p>0.05). The increase in LVEF in the main group was 4.4% (p<0.001), while the control group showed a minimal increase of 0.8% (p=0.068). The incidence of cardiovascular events within 12 months was 5.9% in the main group versus 12.7% in the control group (p=0.006). According to Cox regression analysis, ademetionine therapy was independently correlated with a reduced risk of cardiovascular events (HR=0.51; 95% CI 0.33—0.79; p<0.001). Conclusions. Among elderly patients who have experienced ST-segment elevation myocardial infarction, there are observable slight improvements in liver function tests and left ventricular ejection fraction following standard therapy. The use of ademetionine is associated with more pronounced improvements in laboratory, instrumental, and clinical outcomes, warranting further investigation in randomized clinical trials.