Abstract
Background: There is uncertainty whether uric acid level could be used as a prognostic marker in acute ST elevation myocardial infarction (STEMI) patients. Furthermore, there is a need to find a simple, less expensive but accurate marker that could be use in rural areas where fibrinolytic treatment is the first choice of acute reperfusion therapy. We studied the association of uric acid levels on cardiovascular event in patients with STEMI receiving fibrinolytic treatment. Methods: Seventy-five patients with acute STEMI, eligible for fibrinolytic therapy, were enrolled in this cohort study. Over a night of fasting period, uric acid level was measured. One month clinical follow up was done. Reinfarction, heart failure, urgent revascularization, recurrent angina and death were defined as end point of the study. Results: In STEMI patients with lowest uric acid levels ( 7.3 mg/dl), the cardiovascular event rate increased from 8% to 20%. From multivariate Cox regression analysis showed that elevated levels of uric acid (>7.3 mg/dl) demonstrated an independent, significant positive relation to cardiovascular events [Hazard Ratio 3.10 (95% Confidence Interval 1.16 to 8.29), p <0.024]. Conclusion: Serum uric acid is an independent predictor of cardiovascular event in patients with post fibrinolytic treatment in acute STEMI.
Highlights
Previous trials suggest that uric acid might be an independent predictor of major adverse cardiovascular events (MACE) in patients with coronary artery disease or only an indirect marker of adverse event due to the association between uric acid and other cardiovascular risk factors [1,2,3,4,5]
To explore the relation between uric acid and myocardial infarction, we investigated the predictive role of uric acid on the risk of cardiovascular event from 75 consecutive patients with acute ST elevation myocardial infarction (STEMI) receiving fibrinolytic treatment
No statistically differences were observed in location of MI (13% Vs 18%, p=0.329), and in use of angiotensin converting enzyme inhibitor (13% Vs 20%, p= 0.169) between the lowest and the highest uric acid quartile
Summary
Previous trials suggest that uric acid might be an independent predictor of major adverse cardiovascular events (MACE) in patients with coronary artery disease or only an indirect marker of adverse event due to the association between uric acid and other cardiovascular risk factors [1,2,3,4,5].Several theories have been discussed, such as high serum uric acid has impact on increasing platelet reactivity [6], mediating inflammation, and stimulation of smooth muscle cell proliferation [7,8], which probably worsened the acute thrombosis complication. There is a need to find a simple and accurate prognostic marker that could be used in a remote area where fibrinolytic therapy is the first choice of acute reperfusion therapy (as part of pharmacoinvasive strategy) in non PCI capable hospitals especially in developing countries. To explore the relation between uric acid and myocardial infarction, we investigated the predictive role of uric acid on the risk of cardiovascular event from 75 consecutive patients with acute STEMI receiving fibrinolytic treatment. There is uncertainty whether uric acid level could be used as a prognostic marker in acute ST elevation myocardial infarction (STEMI) patients. There is a need to find a simple, less expensive but accurate marker that could be use in rural areas where fibrinolytic treatment is the first choice of acute reperfusion therapy. We studied the association of uric acid levels on cardiovascular event in patients with STEMI receiving fibrinolytic treatment
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