Prognostic value of De Ritis ratio in patients with acute myocardial infarction

Ndrepepa, Gjin; Holdenrieder, Stefan; Kastrati, Adnan

doi:10.1016/j.cca.2022.08.016

Cited by 11 publications

(9 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…De Ritis ratio is a readily available marker of liver disease 2 . An association of De Ritis ratio with an increased risk of mortality has been reported in patients with acute myocardial infarction, 15,16 type 2 diabetes, 27 arterial hypertension, 28 and contrast‐induced acute kidney injury after elective PCI 29 . So far, only one study (a retrospective cohort of 203 patients with stable CAD analysed over a mean follow‐up of 749 days) has assessed the association between De Ritis ratio and mortality in patients with stable CAD after elective PCI 17 .…”

Section: Discussionmentioning

confidence: 99%

“…2 Elevated De Ritis ratio reflects hepatocyte injury, progressive liver damage and fibrosis. 14 Recent studies have shown that elevated De Ritis ratio is associated with an increased risk of mortality in patients with acute myocardial infarction 15,16 and stable CAD. 17 Although CLD increases the risk for bleeding and thrombotic/ischemic events, 18 no study so far has assessed the association of De Ritis ratio with bleeding or thrombotic events in patients with chronic coronary syndromes (CCS) after PCI.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

De Ritis ratio and long‐term major cardiovascular adverse events in patients undergoing elective percutaneous coronary intervention

Ndrepepa

Holdenrieder

Kastrati

2023

Eur J Clin Investigation

Self Cite

View full text Add to dashboard Cite

Background:The association of aspartate aminotransferase to alanine aminotransferase ratio (De Ritis ratio) with clinical outcomes in patients with chronic coronary syndromes (CCS) remains unclear. This study aims to assess the association of De Ritis ratio with adverse cardiovascular events in patients with CCS. Materials and Methods:The study included 5020 patients with CCS undergoing percutaneous coronary intervention. Patients were categorized into groups according to tertiles of the De Ritis ratio: tertile 1 (De Ritis ratio: <.75; n = 1688 patients), tertile 2 (De Ritis ratio: .75-1.08; n = 1666 patients) and tertile 3 (De Ritis ratio: >1.08; n = 1666 patients). The primary endpoint was 3-year mortality.Results: At 3 years, there were 384 deaths, 176 myocardial infarctions and 61 strokes. In groups with De Ritis in the 1st, 2nd and 3rd tertiles, deaths occurred in 5.0%, 7.5% and 14.5% of the patients, respectively (adjusted hazard ratio = 1.09, 95% confidence interval [1.06-1.12], p < .001); myocardial infarctions occurred in 2.6%, 3.5% and 5.1% of the patients, respectively (p < .001); strokes occurred in 1.0%, 1.2% and 1.9% of the patients, respectively (p = .030); bleeding at 30 days (n = 112) occurred in 1.4%, 1.6% and 3.7% of the patients, respectively (p < .001).The C-statistic of the Cox proportional hazards model for all-cause mortality with baseline data without the De Ritis ratio was .815 [.794-.836] and .818 [.797-.838] after the inclusion of the De Ritis ratio (delta C-statistic = .003; p = .005). Conclusions:In patients with CCS undergoing percutaneous coronary intervention, an elevated De Ritis ratio was associated with long-term major adverse cardiovascular events. K E Y W O R D S alanine aminotransferase, aspartate aminotransferase, De Ritis ratio, elective PCI, MACE, prognosisHow to cite this article: Ndrepepa G, Holdenrieder S, Kastrati A. De Ritis ratio and long-term major cardiovascular adverse events in patients undergoing elective percutaneous coronary intervention.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

De Ritis ratio and long‐term major cardiovascular adverse events in patients undergoing elective percutaneous coronary intervention

Ndrepepa

Holdenrieder

Kastrati

2023

Eur J Clin Investigation

Self Cite

View full text Add to dashboard Cite

show abstract

“…The AST/ALT ratio has been associated with oxidative stress and systemic inflammation [12]. Despite being initially suggested as a marker for liver function impairment severity, recent studies have found that the AST/ALT ratio is linked to mortality in a variety of patient subgroups, including myocardial infarction, cardiac arrest, heart failure, sepsis, hypertension, type 2 diabetes, and even COVID-19 patients [10,[15][16][17][18][19][20][21][22][23]. For example, in patients with acute myocardial infarction, an elevated AST/ALT ratio has been linked to both short-and longterm mortality risks [17,18].…”

Section: Plos Onementioning

confidence: 99%

“…Despite being initially suggested as a marker for liver function impairment severity, recent studies have found that the AST/ALT ratio is linked to mortality in a variety of patient subgroups, including myocardial infarction, cardiac arrest, heart failure, sepsis, hypertension, type 2 diabetes, and even COVID-19 patients [10,[15][16][17][18][19][20][21][22][23]. For example, in patients with acute myocardial infarction, an elevated AST/ALT ratio has been linked to both short-and longterm mortality risks [17,18]. For acute and older heart failures, Maeda et al [15,16] demonstrated that the AST/ALT ratio may be associated with malnutrition, frailty, cachexia, and poor clinical outcomes.…”

Section: Plos Onementioning

confidence: 99%

Non-linear association between aspartate aminotransferase to alanine aminotransferase ratio and mortality in critically ill older patients: A retrospective cohort study

Yang,

Meng,

Xin

et al. 2023

PLoS ONE

View full text Add to dashboard Cite

Background The aspartate aminotransferase to alanine aminotransferase (AST/ALT) ratio has been shown to be associated with poor clinical outcomes across various patient groups. However, little is unclear about the association between the two in critically ill older patients. Therefore, we aim to investigate the association of the AST/ALT ratio with hospital mortality in this special population. Methods In this retrospective cohort study, we extracted elderly patients (age ≥ 65 years) from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. The primary outcome was in-hospital mortality. The association between the AST/ALT ratio and hospital mortality was studied using univariable and multivariable Cox regression analysis, as well as restricted cubic splines (RCS). Survival analysis was performed using the Kaplan-Meier (KM) method according to the AST/ALT ratio. Results Among the 13,358 eligible patients, the mean age was 77.6 years, 7,077 patients (52.9%) were male, and 2,511 patients (18.8%) died in hospital. The AST/ALT ratio was found to be independently associated with in-hospital mortality (HR = 1.05, 95% CI: 1.01–1.09, P = 0.022) after adjusting for potential confounders. Furthermore, a non-linear relationship and saturation effect were observed between them, with the inflection point being 1.80. When the AST/ALT ratio was less than 1.80, we found that every 1 unit increase in the AST/ALT ratio resulted in a 39% increased risk of in-hospital mortality (HR = 1.39, 95% CI: 1.18–1.64, P < 0.001). However, when the AST/ALT ratio was greater than 1.80, the association became saturated (HR = 1.01, 95% CI: 0.96–1.07, P = 0.609). Sensitivity and subgroup analyses showed the results were robust. Conclusion In critically ill older patients, the association between the AST/ALT ratio and in-hospital mortality was non-linear and showed a saturation effect. An elevated AST/ALT ratio was significantly associated with increased in-hospital mortality when the AST/ALT ratio was less than 1.80.

show abstract

“…Percutaneous coronary intervention (PCI) has reduced the incidence of major adverse cardiovascular and cerebrovascular events (MACCE) in patients with stable coronary artery disease (SCAD) with sufficient evidence of ischemia; however, some patients still have a poor prognosis [ 1 ]. Recent studies have shown that a high aspartate aminotransferase-to-alanine aminotransferase ratio (De Ritis ratio) is associated with a worse prognosis in patients with acute myocardial infarction [ 2 , 3 ] and acute heart failure [ 4 ]. Study also have shown that an elevated De Ritis ratio on admission was significantly associated with intensive care unit mortality and hospital mortality after cardiac arrest [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Impact of the De Ritis Ratio on the Prognosis of Patients with Stable Coronary Artery Disease Undergoing Percutaneous Coronary Intervention

et al. 2022

View full text Add to dashboard Cite

The aim of this study was to emphasize the impact of the aspartate aminotransferase-to-alanine aminotransferase ratio (De Ritis ratio) on the prognosis of patients with stable coronary artery disease (SCAD) undergoing percutaneous coronary intervention (PCI). Material/Methods:Patients with SCAD who underwent elective PCI at Shinonoi General Hospital were included. SCAD was defined as epicardial coronary artery diameter stenosis ³90% or epicardial coronary artery diameter stenosis ³75% accompanied by symptoms or stress-induced myocardial ischemia. Clinical data were collected, and cardiovascular events were followed after discharge. One-way Cox proportional risk analysis was performed to assess the risk stratification value of the De Ritis ratio, using major adverse cardiac and cerebrovascular events (MACCE) and all-cause mortality as the primary and secondary endpoints, respectively. The independent risk stratification value was evaluated by multivariate Cox proportional risk analysis. Results:Among 204 patients with SCAD undergoing PCI, during a median follow-up period of 706 days (24 months), 13.7% (28/204) patients experienced MACCE, and 8.8% (18/204) experienced all-cause mortality. Multifactorial Cox regression analysis revealed that a high De Ritis ratio was an independent risk factor for MACCE (HR=2.96, 95% CI: 1.29-6.78, P=0.01) and all-cause mortality (HR=3.61, 95% Cl: 1.31-9.86, P=0.012). The sensitivity analysis further confirmed the incremental value of the De Ritis ratio for adverse cardiovascular events. Conclusions:A high De Ritis ratio was an independent and valuable risk stratification factor for MACCE and all-cause mortality in patients with SCAD after PCI.

show abstract

Prognostic value of De Ritis ratio in patients with acute myocardial infarction

Cited by 11 publications

References 28 publications

De Ritis ratio and long‐term major cardiovascular adverse events in patients undergoing elective percutaneous coronary intervention

De Ritis ratio and long‐term major cardiovascular adverse events in patients undergoing elective percutaneous coronary intervention

Non-linear association between aspartate aminotransferase to alanine aminotransferase ratio and mortality in critically ill older patients: A retrospective cohort study

Impact of the De Ritis Ratio on the Prognosis of Patients with Stable Coronary Artery Disease Undergoing Percutaneous Coronary Intervention

Contact Info

Product

Resources

About