High serum uric acid levels may increase mortality and major adverse cardiovascular events in patients with acute myocardial infarction

Abstract

Objectives:To determine the validity of uric acid as a potential prognostic marker for long-term outcomes of patients with acute myocardial infarction (AMI) and those with AMI undergoing percutaneous coronary intervention (PCI).Methods:Systematic review and meta-analysis were performed. We retrieved data from retrospective and prospective cohort studies that investigated whether serum uric acid (SUA) level affects the prognosis of patients with AMI.Results:Thirteen studies involving 9371 patients were included. High serum uric acid (HSUA) level increased mid/long-term mortality (risk ratio (RR)=2.32, 95% confidence intervals (CI): 2.00–2.70) and had higher short-term mortality (RR=3.09, 95% CI: 2.58–3.71), higher mid/long-term major adverse cardiovascular events (MACE) risk (RR=1.70, 95% CI: 1.54–1.88), and higher short-term MACE risk (RR=2.47, 95% CI: 2.08–2.92) for patients with AMI. In the PCI subgroup, the HSUA level also increased mid/long-term mortality (RR=2.33, 95% CI: 1.89 to 2.87) and had higher mid/long-term MACE risk (RR=1.64, 95% CI: 1.48–1.82), and higher short-term MACE risk (RR 2.43, 95% CI: 2.02–2.93) for patients who were treated with PCI after AMI. Particularly in the PCI subgroup, a higher short-term mortality (RR=6.70, 95% CI: 3.14–14.31) was presented in the group with lower HSUA cut-off level, and the mortality was higher than the group with higher HSUA cut-off level (RR=2.69, 95% CI: 2.09–3.46).Conclusion:The HSUA level significantly increased the mortality and MACE risk of patients with AMI. Mild elevation of SUA levels (normal range) have started to have a significant impact on the short-term mortality of patients who underwent PCI, and has not received the attention of previous studies. However, this condition should be further investigated.

Prognostic value of hyperuricemia in patients with acute coronary syndrome: A meta‐analysis

“…The prognostic role of uric acid level has been widely evaluated in patients with AMI. In line with our meta‐analysis, a previously well‐designed meta‐analysis has concluded that higher SUA level independently predicted the short‐term or mid/long‐term all‐cause mortality and MACEs in AMI patients. However, most of the included studies enrolled patients with ST segment elevated myocardial infarction.…”

“…Lower excretion increased synthesis or both contribute to higher circulating uric acid level . Serum uric acid (SUA) level has been recognized as a prognostic biomarker in patients with acute myocardial infarction (AMI) . Findings from observational studies have linked the high SUA level and adverse prognosis in ACS patients.…”

“…3 Serum uric acid (SUA) level has been recognized as a prognostic biomarker in patients with acute myocardial infarction (AMI). 4 Findings from observational studies have linked the high SUA level and adverse prognosis in ACS patients. However, the prognostic significance of SUA in patients with ACS remains controversial.…”

Serum uric acid and risk of cardiovascular mortality: a systematic review and dose-response meta-analysis of cohort studies of over a million participants

“…The relationship between SUA and CVD was first reported more than 50 years ago, and several epidemiological studies were conducted to assess the association between hyperuricemia (HU) and CVD [5]. Although many studies have been conducted assessing the relationship between UA and CVD, there is disagreement about this relationship [6]. These controversies are due to the dual effect of UA in the body [7].…”

Uric acid variability at midlife as an independent predictor of coronary heart disease and all-cause mortality

“…Serum uric acid (SUA) has long been associated with dyslipidemia, diabetes, hypertension, coronary calcifications and renal failure [1–3]. It has been suggested that elevated SUA may be associated with mortality in high risk patients with asymptomatic carotid atherosclerotic disease, acute myocardial infarction, heart failure, diabetes mellitus and hypertension [4–7]. The role of SUA as an independent risk factor for CV mortality is questionable.…”