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

Autor:	Sebastian Schnaubelt, Georg Goliasch, Patrick Sulzgruber, Stefan Forster, Lorenz Koller, Klaus Distelmaier, Johann Wojta, Aurel Toma, Feras El-Hamid, Max-Paul Winter, Christian Hengstenberg, Alexander Niessner, Thomas Reiberger, Matthias Steininger
Jazyk:	angličtina
Rok vydání:	2018
Předmět:	0301 basic medicine medicine.medical_specialty Acute coronary syndrome ALT lcsh:Medicine Article De-Ritis ratio acute coronary syndrome 03 medical and health sciences 0302 clinical medicine Interquartile range Internal medicine Medicine Myocardial infarction long-term prognosis AST biology business.industry Proportional hazards model Hazard ratio lcsh:R General Medicine medicine.disease Confidence interval 030104 developmental biology Alanine transaminase 030220 oncology & carcinogenesis biology.protein Cardiology Creatine kinase business
Zdroj:	Journal of Clinical Medicine Volume 7 Issue 12 Journal of Clinical Medicine, Vol 7, Iss 12, p 474 (2018)
ISSN:	2077-0383
Popis:	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 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.
Databáze:	OpenAIRE
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