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

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.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.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).In patients with CCS undergoing percutaneous coronary intervention, an elevated De Ritis ratio was associated with long-term major adverse cardiovascular events.