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Open AccessArticle

De-Ritis Ratio Improves Long-Term Risk Prediction after Acute Myocardial Infarction

1
Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria
2
Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, 1090 Vienna, Austria
3
Vienna Hepatic Hemodynamic Laboratory, Medical University of Vienna, 1090 Vienna, Austria
4
Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria
*
Author to whom correspondence should be addressed.
These two authors contributed equally in this work.
J. Clin. Med. 2018, 7(12), 474; https://doi.org/10.3390/jcm7120474
Received: 26 September 2018 / Revised: 28 October 2018 / Accepted: 14 November 2018 / Published: 23 November 2018
(This article belongs to the Section Cardiology)
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Abstract

Background: Recent evidence suggested levels of aspartate aminotransferase (AST), alanine transaminase (ALT), and AST/ALT ratio (De-Ritis ratio) were associated with a worse outcome after acute myocardial infarction (AMI). However, their value for predicting long-term prognosis remained unknown. Therefore, we investigated the prognostic potential of transaminases on patient outcome after AMI from a long-term perspective. Methods: Data of a large AMI registry including 1355 consecutive patients were analyzed. The Cox regression hazard analysis was used to assess the impact of transaminases and the De-Ritis ratio on long-term mortality. Results: The median De-Ritis ratio for the entire study population was 1.5 (interquartile range [IQR]: 1.0–2.6). After a median follow-up time of 8.6 years, we found that AST (crude hazard ratio (HR) of 1.19 per 1-SD [95% confidence interval (CI): 1 .09–1.32; p < 0.001]) and De-Ritis ratio (crude HR of 1.31 per 1-SD [95% CI: 1.18–1.44; p < 0.001]), but not ALT (p = 0.827), were significantly associated with long-term mortality after AMI. After adjustment for confounders independently, the De-Ritis ratio remained a strong and independent predictor for long-term mortality in the multivariate model with an adjusted HR of 1.23 per 1-SD (95% CI: 1.07–1.42; p = 0.004). Moreover, the De-Ritis ratio added prognostic value beyond N-terminal pro-B-Type Natriuretic Peptide, Troponin T, and Creatine Kinase. Conclusion: The De-Ritis ratio is a strong and independent predictor for long-term mortality after AMI. As a readily available biomarker in clinical routine, it might be used to identify patients at risk for fatal cardiovascular events and help to optimize secondary prevention strategies after AMI. View Full-Text
Keywords: acute coronary syndrome; De-Ritis ratio; AST; ALT; long-term prognosis acute coronary syndrome; De-Ritis ratio; AST; ALT; long-term prognosis
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Steininger, M.; Winter, M.-P.; Reiberger, T.; Koller, L.; El-Hamid, F.; Forster, S.; Schnaubelt, S.; Hengstenberg, C.; Distelmaier, K.; Goliasch, G.; Wojta, J.; Toma, A.; Niessner, A.; Sulzgruber, P. De-Ritis Ratio Improves Long-Term Risk Prediction after Acute Myocardial Infarction. J. Clin. Med. 2018, 7, 474.

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