Abstract
BACKGROUND: The aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio, commonly referred to as the DeRitis ratio, serves as an indicator of liver disease severity and has been linked to several cardiovascular risk factors. This study aimed to explore the relationship between the DeRitis ratio (AST/ALT) and long-term adverse outcomes in patients diagnosed with acute coronary syndrome (ACS). METHODS: We selected 8,429 patients with ACS from the OPT-CAD database who were admitted between 2012 and 2014 and had complete AST and ALT measurements. Following propensity score matching (PSM), 5,680 patients were included in the final analysis. A retrospective survival analysis was conducted to evaluate the relationship between the DeRitis ratio and the occurrence of net adverse clinical events (NACE) within 5 years post-discharge. The primary outcome was NACE, defined as a composite of all-cause mortality, stroke, non-fatal myocardial infarction (MI), and major bleeding [Bleeding Academic Research Consortium (BARC) types 2-5]. RESULTS: Following PSM, the cumulative incidence of NACE within 5 years was significantly higher in the group with a DeRitis ratio ≥1 compared to the group with a DeRitis ratio <1 (HR: 1.21; 95% CI: 1.05-1.38; P = 0.0071). After adjusting for confounding factors using Cox multivariable analysis, the association persisted as significant (HR: 1.21; 95% CI: 1.06-1.39; P = 0.006). Subgroup analysis indicated that the high-ratio group had a significantly increased risk of major bleeding (HR: 1.27; 95% CI: 1.01-1.59; P = 0.037). However, the cumulative risk of all-cause death showed a strong trend towards increase but did not reach statistical significance (HR: 1.23; 95% CI: 0.99-1.51; P = 0.052). There were no significant differences between the groups in the cumulative risks of non-fatal myocardial infarction (MI) (HR: 1.22; 95% CI: 0.89-1.67; P = 0.21), or stroke (HR: 1.01; 95% CI: 0.78-1.32; P = 0.92). CONCLUSION: The DeRitis ratio ≥1 is significantly associated with elevated risk of NACE during the 5-year post-discharge period in ACS patients. Additionally, an elevated DeRitis ratio is correlated with a higher incidence of major bleeding events.