Zhongguo quanke yixue (Feb 2022)
Serum Uric Acid and Long-term Prognosis in Patients with Acute Myocardial Infarction
Abstract
BackgroundIt is still controversial whether or not serum uric acid, a key risk for coronary heart disease, is significantly associated with prognosis of acute myocardial infarction (AMI) . And there are rare large-scale and multicenter studies on serum uric acid and long prognosis of AMI in China.ObjectiveTo investigate the relationship between serum uric acid and long-term prognosis in AMI patients.MethodsOne thousand and ninety-eight AMI patients from 9 hospitals (Chengdu First People's Hospital, Chengdu Second People's Hospital, the Third People's Hospital of Chengdu, the First Affiliated Hospital of Chengdu Medical College, Dujiangyan Medical Center, Pidu District People's Hospital, Chengdu, Shuangliu District First People's Hospital, Jintang First People's Hospital, the People's Hospital of Pengzhou) in Chengdu during September 2016 to July 2019 were consecutively reSScruited. Baseline data were collected via the electronic medical record system of each hospital by trained professionals, including: (1) demographic data: age, gender, prevalence of smoking; (2) clinical complications and related information: hypertension, diabetes, blood pressure, heart rate, Killip class, AMI type (NSTEMI or STEMI) , prevalence of percutaneous coronary intervention (PCI) ; (3) laboratory parameters: serum SScreatinine (Scr) , uric acid (UA) , triglyceride (TG) , total cholesterol (TC) , low-density lipoprotein cholesterol (LDL-C) , high-density lipoprotein cholesterol (HDL-C) , estimated glomerular filtration rate (eGFR) ; (4) post-discharge medication: aspirin, clopidogrel/tigrelol, statins, Beta-blockers, ACEI/ARB, diuretics. Baseline data were compared between patients with and without major adverse cardiovascular and cerebrovascular events (MACCE) during post-discharge follow-up. Then, prognosis was compared aSScross UA tertile subgroups〔A: UA<420 μmol/L; B: 420 ≤UA<480 μmol/L; C: UA≥480 μmol/L〕 stratified by the diagnostic SScriteria for hyperuricemia in Guideline for the Diagnosis and Management of Hyperuricemia and Gout in China (2019) .ResultsThe median follow-up time for all participants was 14.5 (9.2, 20.7) months. Of all cases, 173 were found with MACCE, and 366 with hyperuricemia. Compared with those without MACCE, patients with MACCE had greater average age, Scr and UA, and heart rate, and higher female ratio, higher prevalence of hypertension, diabetes, use of diuretics, and Killip class≥3, but lower prevalence of PCI treatment (P<0.05) . Subgroup A had much lower incidence of MACCE, all-cause death and cardiac death than subgroup B or C (P<0.01) . Kaplan-Meier survival analysis indicated that the cumulative incidence of MACCE, all-cause death and cardiac death either in subgroup B or C was higher than that in subgroup A (P<0.01) . Cox regression analysis showed that Killip class ≥3〔HR=1.812, 95%CI (1.215, 2.700) 〕, older age〔HR=1.045, 95%CI (1.031, 1.059) 〕 and higher UA level〔 (≥420 μmol/L but<480 μmol/L: HR=1.614, 95%CI (1.062, 2.455) ; ≥480 μmol/L: HR=1.949, 95%CI (1.327, 2.862) 〕 were independent risk factors for long-term MACCE events in patients with AMI (P<0.05) . Serum UA had an AUC (95%CI) of 0.578 (0.548, 0.607) with 0.387 sensitivity, and 0.779 specificity in predicting long-term incidence of MACCE, an AUC (95%CI) of 0.645 (0.616, 0.674) with 0.598 sensitivity, and 0.670 specificity in predicting long-term incidence of all-cause death, and an AUC (95% CI) of 0.653 (0.624, 0.681) with 0.534 sensitivity, and 0.761 specificity in predicting long-term incidence of cardiac death.ConclusionElevated serum UA was associated with higher risk of long-term adverse events in AMI patients. Serum UA may be used as a predictor for long-term MACCE events in such patients.
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