De Ritis Ratio as Major Adverse Cardiovascular Events Predictor Up to 30 Days After Hospital Discharge in Acute Myocardial Infarction Patients Undergoing Percutaneous Coronary Intervention

Primanto Tantiono*, I Kadek Susila Surya Darma, Hendy Wirawan

Abstract

Background: Aspartate aminotransferase (AST) and alanine transaminase (ALT) are commonly used to assess liver function, but they also increase in acute myocardial infarction (AMI) as a result of myocardial injury and hemodynamic compromise. ALT is relatively specific for hepatocellular injury, whereas AST is also present in cardiac tissue and rises during cellular necrosis. Therefore, the AST/ALT (De Ritis) ratio has been proposed as a potential marker for end-organ ischemic injury. This study aimed to evaluate the prognostic value of the De Ritis ratio in AMI patients undergoing percutaneous coronary intervention (PCI). Methods: A retrospective cohort study was conducted on patients with STEMI and NSTEMI undergoing PCI. Blood samples were taken upon emergency department admission to measure AST and ALT, and the De Ritis ratio was calculated. Major adverse cardiovascular events (MACE) were assessed during hospitalization and up to 30 days after discharge. Receiver operating characteristic analysis determined the optimal cutoff, while Kaplan–Meier and Cox regression analyses were used for outcome evaluation. Results: Among 278 patients, in-hospital MACE occurred significantly more often in those with a De Ritis ratio ≥2.03 (p = 0.014). A high De Ritis ratio was an independent predictor of in-hospital MACE (HR = 1.842, p = 0.001), along with pre-procedural TIMI flow, hs-troponin, and NLR. However, the De Ritis ratio was not an independent predictor of 30-day MACE (HR = 2.208, p = 0.557). Conclusion: The De Ritis ratio independently predicts in-hospital MACE in AMI patients undergoing PCI.

Keywords

acute myocardial infarction; De Ritis ratio; major adverse cardiovascular events

Cite This Article

Tantiono, P., Darma, I. K. S. S., Wirawan, H. (2025). De Ritis Ratio as Major Adverse Cardiovascular Events Predictor Up to 30 Days After Hospital Discharge in Acute Myocardial Infarction Patients Undergoing Percutaneous Coronary Intervention. International Journal of Scientific Advances (IJSCIA), Volume 6| Issue 6: Nov – Dec 2025, Pages 1262-1274 URL: https://www.ijscia.com/wp-content/uploads/2025/12/Volume6-Issue6-Nov-Dec-No.1004-1262-1274.pdf

Volume 6 | Issue 6: Nov – Dec 2025