The influence of serum uric acid on coronary atherosclerosis plaque phenotypes by computed tomography angiography: The missing link?

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The interaction of serum uric acid (SUA) with atherogenesis is incompletely understood. Aim of our study was to investigate the association of SUA levels with coronary plaque composition including high-risk-plaque (HRP) features by coronary computed tomography angiography (CTA) and for the prediction of major adverse cardiac events (MACE). 1242 patients (age 66.17±11.03; 56% males) referred to coronary CTA were included. SUA>6.5mg/dl was defined as hyperuricemia. CTA-image analysis included: Coronary stenosis severity (CADRADS), plaque burden (SIS/G-score weighted for non-calcifying plaque), plaques types (1=calcifying; 2=mixed (predominantly calcifying); 3=mixed (predominantly noncalcifying), 4=noncalcifying."High-risk-plaque"(HRP)-features were quantified: Low-attenuation plaque (LAP) density, Spotty calcification, Napkin-Ring Sign (NRS), Remodeling Index. Coronary Artery Calcium Score (CAC) was measured. Primary outcome was MACE. HRP-features were more prevalent in patients with hyperuricemia (p=0.005, p=0.0002, p=0.0004). SUA level was associated with LAP<30HU (HR:1.23; p=0.04). Plaque burden and CAC-score were higher in the hyperuricemia group (G-score:p=0.022 and CAC:p=0.027). After a mean follow-up of mean 8,32 years, MACE rate was 2.9%. There was no difference in the MACE rate between subjects with elevated SUA and normals (HR 1.221:95%CI:0.817-2.563; p=0.597). Low-attenuation-plaque density/LAP<30HU was the strongest prognosticator for MACE (p=0.033 and p=0.013); stenosis severity, plaque types and G-score were also predictive, but not SUA, CAC and the other conventional cardiovascular risk factors (except smoking). SUA is associated with HRP-features and coronary plaque burden. Low attenuation plaque is the strongest predictor of MACE, but not SUA level and other major CVRF. CTA imaging biomarkers may improve CV-risk stratification in patients with hyperuricemia.