acute myocardial infarction, alanine aspartate aminotransferase to lymphocyte ratio, MIMIC‐III database, prognosis, Immunologic diseases. Allergy, RC581-607

Abstract Background This study aimed to investigate the clinical value and prognostic significance of the alanine aspartate aminotransferase‐to‐lymphocyte ratio index (ALRI) in patients diagnosed with acute myocardial infarction (AMI). Methods Clinical indices of patients with AMI were collected from the Medical Information Mark for Intensive Care (MIMIC) III database and Wuhan Sixth Hospital. Cox regression analysis was used to explore whether ALRI was a risk factor for a worse prognosis in patients with AMI, and a nomogram including ALRI was created to estimate its predictive performance for 28‐day mortality. Results Based on clinical data from the MIMIC‐III database, we found that a high ALRI was closely associated with a variety of clinical parameters. It was an important risk factor for 28‐day survival in patients with AMI (HR = 5.816). ALRI had a high predictive power for worse 28‐day survival in patients with AMI (area under the curve [AUC] = 0.754). Additionally, we used clinical data from the Wuhan Sixth Hospital to verify the predictive power of ALRI in patients with AMI, and a high level of ALRI remained an independent risk factor for worse survival in patients with AMI (HR = 4.969). The AMI nomogram, including ALRI, displayed a good predictive performance for 28‐day mortality in both the MIMIC‐III (AUC = 0.826) and Wuhan Sixth Hospital cohorts (AUC = 0.795). Conclusion The ALRI is closely related to the survival outcomes of patients with newly diagnosed AMI, indicating that it could serve as a novel biomarker for risk stratification such patients.