Prognostic Significance of Hyperuricemia in Patients with Different Types of Renal Dysfunction and Acute Myocardial Infarction Treated with Percutaneous Coronary Intervention

Abstract

Aim: This study evaluated the impact of hyperuricemia (HUR) on outcome in patients with different types of impaired renal function (IRF) and acute myocardial infarction (AMI) treated invasively. Methods: Out of 3,593 consecutive AMI patients treated invasively, 1,015 IRF patients were selected. The IRF group consisted of patients with baseline kidney dysfunction (BKD group) and/or patients with contrast-induced nephropathy (CIN group). HUR was defined as a serum uric acid concentration (SUAC) >420 µmol/l (>7 mg/dl). Independent predictors of death and major adverse cardiovascular events (MACE) were selected by the multivariate Cox-regression model. Results: Remote mortality rates were higher in HUR patients: IRF (32.7 vs. 18.6%), BKD (41.3 vs. 25.9%), CIN (35.4 vs. 16.7%); all p < 0.001. HUR was an independent predictor of death in BKD (hazard ratio (HR) 1.38, p < 0.05). Each 100-µmol/l increase in SUAC was associated with a significant increase of HR for mortality: 1.087 in IRF patients, 1.108 in BKD patients, 1.128 in CIN patients; all p < 0.05. Remote major adverse cardiovascular event rates were higher in HUR patients: IRF (55.4 vs. 48.9%), CIN (56.8 vs. 48%); both p < 0.05. Conclusions: In AMI patients treated invasively, an increase in SUAC is an independent predictor of death within all types of renal dysfunction; HUR defined as SUAC >420 µmol/l (>7 mg/dl) is a predictor only in BKD patients.

Multifactorial treatment for improvement of renal function and cardiovascular risk: an ATTEMPT for patients with metabolic syndrome and chronic kidney disease

“…These findings were also confirmed in meta-analyses 25,26 . Interestingly, similar results have been reported in patients with renal dysfunction [27][28][29][30] , thus highlighting the role of SUA as a possible CVD risk factor in these patients. Furthermore, hyperuricemia has been suggested as a risk factor for CKD development 31,32 and progression 33,34 .…”

Serum Uric Acid Levels and Renal Impairment among ST-Segment Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Intervention

“…The levels of serum uric acid (UA), the end product of purine catabolism, have been shown to correlate with the risk for chronic kidney and ischemic heart diseases [5][6][7][8][9] . Elevated serum UA levels were also associated with increased short-and long-term mortality among myocardial infarction patients [10][11][12][13] . Previous studies have shown that elevated UA levels increase the risk of AKI in patients undergoing cardiac surgery [14,15] and nonemergent PCI [16] .…”

Linking uric acid metabolism to diabetic complications

“…Moreover, there is epidemiological evidence of an association between hyperuricemia and mortality in patients undergoing percutaneous coronary intervention or presenting with acute myocardial infarction [71][72][73] . Our study showed that SUA is an independent risk factor for vascular complications, even when adjusted for several confounders, including eGFR [56] .…”