Abstract
Introduction: Investigating the clinical impact of serum uric acid (UA) and its lowering agents on the complications and mortality of acute ST-elevation myocardial infarction (STEMI) can open a new era in STEMI treatment. The aim of this study was to evaluate the effect of on admission serum UA level on the mortality and morbidity of patients admitted with STEMI. Methods: A number of 608 patients with STEMI were enrolled in this study from December 21, 2012 until February 19, 2014. Patients were followed for 20 months. Male to female ratio was 2.53, and the mean age of patients was 62.6±13.4. The relationship between the level of UA and patients’ mortality and morbidity, left ventricular ejection fraction (LVEF), atrial and ventricular arrhythmia was analyzed. Results: Patients with high serum UA level had higher Killip class after STEMI (P=0.001). Mean LVEF was measured to be 39.5±9.6 in normal UA group and 34.6±11.6 in high UA group (P=0.001). In comparison with normal UA group, high UA group had significantly higher cTnI (2.68±0.09 vs 4.09±0.42, respectively, P=0.001), increased blood pressure (P=0.009), and higher atrial fibrillation (AF) occurrence (P=0.03), but no association was seen between ventricular tachycardia and serum UA level. Short term and midterm mortality were not different in two groups (P=0.44 and 0.31, respectively). Conclusion: In the current study, high serum UA level in patients with acute myocardial infarction (MI) was not associated with higher in-hospital or midterm mortality, but it was associated with lower LVEF, higher Killip class, elevated cTnI, creatinine, triglyceride, and higher AF.
Highlights
Investigating the clinical impact of serum uric acid (UA) and its lowering agents on the complications and mortality of acute ST-elevation myocardial infarction (STEMI) can open a new era in STEMI treatment
Endothelium degrades adenosine to uric acid (UA) rapidly; so due to increasing the concentration of UA and decreasing the intracellular PH, rapid UA efflux to the vascular lumen occurs.[6]. UA level may be an indicator of severity of ischemia and tissue hypoxia and high serum UA has been stipulated as a risk factor for coronary artery disease (CAD) and somehow as prognostic factor for mortality and morbidity in patients with CAD
Regarding the STEMI risk factors, smoking was more common in normal UA group (P = 0.02), but Increased blood pressure was seen more frequently in high UA group (P = 0.009), and diabetes mellitus and cholesterol level were not different in two groups (P = 0.57 and 0.81, respectively)
Summary
Investigating the clinical impact of serum uric acid (UA) and its lowering agents on the complications and mortality of acute ST-elevation myocardial infarction (STEMI) can open a new era in STEMI treatment. Conclusion: In the current study, high serum UA level in patients with acute myocardial infarction (MI) was not associated with higher in-hospital or midterm mortality, but it was associated with lower LVEF, higher Killip class, elevated cTnI, creatinine, triglyceride, and higher AF. Chen et al showed association between serum UA and adverse events in patients with STEMI.[7] Kroll et al showed that in patients with higher on admission serum UA, short term and long term mortality was increased.[8] In other study done in Iran higher serum UA had association with in-hospital and short term mortality.[9] By developing new treatments especially increasing trend to invasive therapy in high risk patients for example those who develop heart failure after ST-elevation myocardial infarction (STEMI) and continuous effort to decrease STEMI mortality, it is interesting to investigate whether prognostic factors such as serum UA continue to have their prognostic value or not
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