Serum uric acid in patients with acute ST-elevation myocardial infarction

doi:10.5847/wjem.j.issn.1920-8642.2012.01.006

Abstract

Abstract:

BACKGROUND: Few studies investigated serum uric acid levels in patients with acute ST-elevation myocardial infarction (STEMI). The study was to assess the clinical value of serum uric acid levels in patients with acute ST-elevation myocardial infarction (STEMI).

METHODS: Totally 502 consecutive patients with STEMI were retrospectively studied from January 2005 to December 2010. The level of serum lipid, echocardiographic data and in-hospital major adverse cardiovascular events (MACE) in patients with hyperuricemia (n=119) were compared with those in patients without hyperuricemia (n=383). The relationship between the level of serum uric acid and the degree of diseased coronary artery was analyzed. All data were analyzed with SPSS version 17.0 software for Student's t test, the Chi-square test and Pearson's correlation coefficient analysis.

RESULTS: Serum uric acid level was positively correlated with serum triglyceride level. Hyperlipidemia was more common in hyperuricemia patients than in non-hyperuricemia patients (43.7% vs. 33.7%, P=0.047), and serum triglyceride level was significantly higher in hyperuricemia patients (2.11±1.24 vs. 1.78±1.38, P=0.014). But no significant association was observed between serum uric acid level and one or more diseased vessels (P>0.05). Left ventricular end-diastolic diameter (LVEDd) was larger in hyperuricemia patients than in non-hyperuricemia patients (53.52±6.19 vs. 52.18±4.89, P=0.041). The higher rate of left systolic dysfunction and diastolic dysfunction was discovered in hyperuricemia patients (36.4% vs. 15.1%, P<0.001; 68.2% vs. 55.8%, P=0.023). Also, hyperuricemia patients were more likely to have in-hospital MACE (P<0.05).

CONCLUSIONS: Serum uric acid level is positively correlated with serum triglyceride level, but not with the severity of coronary artery disease. Hyperuricemia patients with STEMI tend to have a higher rate of left systolic dysfunction and diastolic dysfunction and more likely to have more in -hospital MACE.

Key words: Acute ST-elevation myocardial infarction, Serum uric acid, Triglyceride, Coronary angiography, Echocardiography, Left ventricular systolic dysfunction, Left ventricular diastolic dysfunction, Major adverse cardiovascular events

Li Chen, Xian-lun Li, Wei Qiao, Zhou Ying, Yan-li Qin, Yong Wang, Yu-jie Zeng, Yuan-nan Ke. Serum uric acid in patients with acute ST-elevation myocardial infarction[J]. World Journal of Emergency Medicine, 2012, 3(1): 35-39.

Figures/Tables 5

Table 1

Table 2

Table 3

Table 4

Table 5

References 16

1	Baker JF, Krishnan E, Chen L, Schumacher HR. Serum uric acid and cardiovascular disease: recent developments, and where do they leave us? Am J Med 2005; 118:816-826. doi: 10.1016/j.amjmed.2005.03.043 pmid: 16084170
2	Brodov Y, Chouraqui P, Goldenberg I, Boyko V, Mandelzweig L, Behar S. Serum uric acid for risk stratification of patients with coronary artery disease. Cardiology 2009; 114:300-305. doi: 10.1159/000239860 pmid: 19776568
3	Bae MH, Lee JH, Lee SH, Park SH, Yang DH, Park HS. et al. Serum uric acid as an independent and incremental prognostic marker in addition to N-terminal pro-B-type natriuretic peptide in patients with acute myocardial infarction. Circ J 2011; 75:1440-1477. doi: 10.1253/circj.CJ-10-0952
4	Thygesen K, Alpert JS, White HD. Joint ESC/ACCF/AHA/WHF Task Force for the Redefinition of Myocardial Infarction, Jaffe AS, Apple FS, et al. Universal definition of myocardial infarction. Circulation 2007; 116:2634-2653. doi: 10.1161/CIRCULATIONAHA.107.187397 pmid: 17951284
5	Kanbay M, Solak Y, Dogan E, Lanaspa MA, Covic A. Uric acid in hypertension and renal disease: the chicken or the egg? Blood Purif 2010; 30:288-295.Epub 2010 Nov 20. doi: 10.1159/000321074 pmid: 21088389
6	Rathmann W, Haastert B, Icks A, Giani G, Roseman JM. Ten-year change in serum uric acid and its relation to changes in other metabolic risk factors in young black and white adults: the CARDIA study. Eur J Epidemiol 2007; 22:439-445. doi: 10.1007/s10654-007-9132-3
7	Lippi G, Montagnana M, Luca Salvagno G, Targher G, Cesare Guidi G. Epidemiological association between uric acid concentration in plasma, lipoprotein (a) and the traditional lipid profile. Clin Cardiol 2010; 33:76-80.
8	Ruggiero C, Cherubini A, Ble A, Bos AJ, Maggio M, Dixit VD. et al. Uric acid and inflammatory markers. Eur Heart J 2006; 27:1174-1181. doi: 10.1093/eurheartj/ehi879 pmid: 16611671
9	Petersen TS, Madsen TV, Jespersen JB, Larsen A, Schmidt EB, Christensen JH. Uric acid in patients with angiographically documented coronary heart disease. Acta Cardiol 2006; 6:525-529.
10	Gur M, Yilmaz R, Demirbag R, Aksoy N. Relation of serum uric acid levels with the presence and severity of angiographic coronary artery disease. Angiology 2008; 59:166-171. doi: 10.1177/0003319706292010 pmid: 18388067
11	Hare JM, Johnson RJ. Uric acid predicts clinical outcomes in heart failure: insights regarding the role of xanthine oxidase and uric acid in disease pathophysiology. Circulation 2003; 107:1951-1953. doi: 10.1161/01.CIR.0000066420.36123.35 pmid: 12707249
12	Kojima S, Sakamoto T, Ishihara M, Kimura K, Miyazaki S, Yamagishi M. et al. Prognostic usefulness of serum uric acid after acute myocardial infarction(the Japanese Acute Coronary Syndrome Study). Am J Cardiol 2005; 96:489-495. doi: 10.1016/j.amjcard.2005.04.007 pmid: 16098298
13	Car S, Trkulja V. Higher serum uric acid on admission is associated with higher short-term mortality and poorer long-term survival after myocardial infarction: retrospective prognostic study. Croat Med J 2009; 50:559-566. doi: 10.3325/cmj.2009.50.559 pmid: 20017224
14	Nadkar MY, Jain VI. Serum uric acid in acute myocardial infarction. J Assoc Physicians India 2008; 56:759-762. pmid: 19263700
15	Windhausen F, Hirsch A, Sanders GT, Cornel JH, Fischer J, van Straalen JP. et al. N-terminal pro-brain natriuretic peptide for additional risk stratification in patients with non-ST-elevation acute coronary syndrome and an elevated troponin T: an Invasive versus Conservative Treatment in Unstable coronary Syndromes (ICTUS) substudy. Am Heart J 2007; 153:485-492. doi: 10.1016/j.ahj.2006.12.012 pmid: 17383283
16	Matsui S, Ishii J, Kitagawa F, Kuno A, Hattori K, Ishikawa M. et al. Pentraxin 3 in unstable angina and non-ST-segment elevation myocardial infarction. Atherosclerosis 2010; 210:220-225.Epub 2009 Nov 5. doi: 10.1016/j.atherosclerosis.2009.10.033 pmid: 19945702

Variables	Non-hyperuricemia (n=383)	Hyperuricemia (n=119)	t / χ²	P
Age	61.19±14.06	61.51±14.01	1.220	0.83
Sex (male%)	335 (87.5)	82 (68.9)^*	5.235	<0.001
Hypertension (%)	197 (51.4)	60 (50.4)	0.037	0.846
Diabetes mellitus (%)	110 (28.9)	41 (34.5)	1.341	0.247
Dyslipidemia (%)	129 (33.7)	52 (43.7)^*	3.951	0.047
Previous coronary artery disease (%)	13 (3.4)	9 (7.6%)	3.765	0.052
Laboratory analysis
SUA (μmol/L)	289.50±73.20	451.87±100.67^*	6.307	<0.001
TC (mmol/L)	4.80±1.01	5.05±1.29	1.918	0.057
TG (mmol/L)	1.78±1.38	2.11±1.24^*	2.466	0.014
HDL-C (mmol/L)	1.02±0.35	1.00±0.29	0.714	0.476
LDL-C (mmol/L)	2.90±0.79	3.04±1.03	1.426	0.156

Variables	r	P
TC	0.083	0.066
TG	0.11	0.018^*
HDL-C	-0.096	0.033^*
LDL-C	0.031	0.486

Echocardiography	Non-hyperuricemia (n=317)	Hyperuricemia (n=110)	t / χ²	P
LVEDd (mm)	52.18±4.89	53.52±6.19^*	2.062	0.041
LVEDd enlarge (%)	87 (27.4)	54 (49.1)^*	7.300	<0.001
LVEF (%)	58.73±9.69	54.44±12.74^*	3.224	0.002

Variables	Non-hyperuricemia (n=383)	Hyperuricemia (n=119)	t / χ²	P
Length of hospital stay (d)	11.85±5.17	12.91±7.04	1.515	0.132
Arrhythmia (%)	25 (6.5)	13 (10.9)	2.509	0.113
Atrioventricular block (%)	20 (5.2)	8 (6.7)	0.388	0.533
Cardiogenic shock (%)	21 (5.5)	14 (11.8)^*	5.524	0.019
Heart failure (%)	62 (16.2)	57 (47.9)^*	6.481	<0.001
LVEF<50% (%)	48 (15.1)	40 (36.4)^*	5.845	<0.001
E/A<1 (%)	177 (55.8)	75 (68.2)^*	5.827	0.023
Stroke (%)	0 (0)	5 (4.2)^*	6.254	<0.001
Acute renal failure (%)	0 (0)	6 (5.0)^*	6.545	<0.001
Overall mortality (%)	23 (6.0)	15 (12.6)^*	3.129	0.017

[1]	Guo-xiong Chen, Hong-na Wang, Jin-lin Zou, Xiao-xu Yuan. Effects of intracoronary injection of nicorandil and tirofiban on myocardial perfusion and short-term prognosis in elderly patients with acute ST-segment elevation myocardial infarction after emergency PCI [J]. World Journal of Emergency Medicine, 2020, 11(3): 157-163.
[2]	Lori Stolz, Josephine Valenzuela, Elaine Situ-LaCasse, Uwe Stolz, Nicolas Hawbaker, Matthew Thompson, Srikar Adhikari. Clinical and historical features of emergency department patients with pericardial effusions [J]. World Journal of Emergency Medicine, 2017, 8(1): 29-33.