Steininger Matthias, Winter Max-Paul, Reiberger Thomas, Koller Lorenz, El-Hamid Feras, Forster Stefan, Schnaubelt Sebastian, Hengstenberg Christian, Distelmaier Klaus, Goliasch Georg, Wojta Johann, Toma Aurel, Niessner Alexander, Sulzgruber Patrick
Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria.
Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, 1090 Vienna, Austria.
J Clin Med. 2018 Nov 23;7(12):474. doi: 10.3390/jcm7120474.
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.
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.
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; < 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 ( = 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; = 0.004). Moreover, the De-Ritis ratio added prognostic value beyond N-terminal pro-B-Type Natriuretic Peptide, Troponin T, and Creatine Kinase.
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.
近期证据表明，急性心肌梗死（AMI）后，天冬氨酸转氨酶（AST）、丙氨酸转氨酶（ALT）水平及AST/ALT比值（德瑞蒂斯比值）与较差的预后相关。然而，它们预测长期预后的价值仍不明确。因此，我们从长期角度研究了转氨酶对AMI患者预后的预测潜力。
分析了一个大型AMI登记处1355例连续患者的数据。采用Cox回归风险分析评估转氨酶和德瑞蒂斯比值对长期死亡率的影响。
整个研究人群的德瑞蒂斯比值中位数为1.5（四分位数间距[IQR]：1.0⁻2.6）。中位随访时间8.6年后，我们发现AST（每1标准差的粗风险比[HR]为1.19[95%置信区间（CI）：1.09⁻1.32；P<0.001]）和德瑞蒂斯比值（每1标准差的粗HR为1.31[95%CI：1.18⁻1.44；P<0.001]），而非ALT（P = 0.827），与AMI后的长期死亡率显著相关。在独立校正混杂因素后，德瑞蒂斯比值在多变量模型中仍是长期死亡率的强有力独立预测因子，校正后HR为每1标准差1.23（95%CI：1.07⁻1.42；P = 0.004）。此外，德瑞蒂斯比值在N末端B型利钠肽原、肌钙蛋白T和肌酸激酶之外增加了预后价值。
德瑞蒂斯比值是AMI后长期死亡率的强有力独立预测因子。作为临床常规中易于获得的生物标志物，它可用于识别有致命心血管事件风险的患者，并有助于优化AMI后的二级预防策略。
