Relation of Coronary Culprit Lesion Morphology Determined by Optical Coherence Tomography and Cardiac Outcomes to Serum Uric Acid Levels in Patients With Acute Coronary Syndrome

Kobayashi, Nobuaki; Hata, Noritake; Tsurumi, Masafumi; Shibata, Yusaku; Okazaki, Hirotake; Shirakabe, Akihiro; Takano, Masamichi; Seino, Yoshihiko; Shimizu, Wataru

doi:10.1016/j.amjcard.2018.03.022

Cited by 13 publications

(7 citation statements)

References 31 publications

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“…The serum levels of UA have been suggested to be a surrogate marker leading to an adverse outcome in patients with critical cardiovascular disease, such as chronic or acute heart failure and ACS. 7,[20][21][22] In the present study, we also showed that elevated serum UA levels were associated with long-term morality in patients requiring intensive care. However, the mechanisms associated with this poor prognosis have been unclear.…”

Section: Adverse Outcomes and The Mechanisms Underlying Ua Elevation supporting

confidence: 76%

The prognostic impact of the uric acid level in patients who require cardiovascular intensive care – is serum uric acid a surrogate biomarker for critical patients in the non-surgical intensive care unit?

Shibata

Shirakabe

Okazaki

et al. 2020

European Heart Journal. Acute Cardiovascular Care

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Background: The prognostic impact of hyperuricemia and the factors that induce hyperuricemia in cardiovascular intensive care patients remain unclear. Methods and results: A total of 3257 emergency department patients were screened, and data for 2435 patients who were admitted to an intensive care unit were analyzed. The serum uric acid level was measured within 15 min of admission. The patients were assigned to a low-uric acid group (uric acid ⩽7.0 mg/dl, n=1595) or a high-uric acid group (uric acid >7.0 mg/dl, n=840) according to their uric acid level on admission. Thereafter, the patients were divided into four groups according to the quartiles of their serum uric acid level (Q1, Q2, Q3 and Q4), and uric acid levels and Acute Physiology and Chronic Health Evaluation II (APACHE II) score. A Kaplan–Meier curve showed a significantly lower 365-day survival rate in a high-uric acid group than in a low-uric acid group, and in Q3 than in Q1 or Q2 and in Q4 than in the other groups. The multivariate logistic regression model for 30-day mortality identified Q4 (odds ratio: 1.856, 95% confidence interval (CI) 1.140–3.022; p=0.013) as an independent predictor of 30-day mortality. The area under the receiver-operating characteristic curve values of the serum uric acid level and APACHE II score for the prediction of 30-day mortality were 0.648 and 0.800, respectively. The category-free net reclassification improvement and integrated discrimination improvement showed that the calculated risk shifted to the correct direction by adding the serum uric acid level to the APACHE II score (0.204, 95% CI 0.065–0.344; p=0.004, and 0.015, 95% CI 0.005–0.025; p=0.004, respectively). The prognosis, including the 365-day mortality, among patients with a high uric acid level and a high APACHE II score was significantly poorer in comparison with other patients. Conclusion: The serum uric acid level, which might be elevated by the various critical stimuli on admission, was an independent predictor in patients who were emergently hospitalized in the intensive care unit. The serum uric acid level is therefore useful as a surrogate biomarker for critical patients in the intensive care unit.

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Section: Adverse Outcomes and The Mechanisms Underlying Ua Elevation supporting

confidence: 76%

The prognostic impact of the uric acid level in patients who require cardiovascular intensive care – is serum uric acid a surrogate biomarker for critical patients in the non-surgical intensive care unit?

Shibata

Shirakabe

Okazaki

et al. 2020

European Heart Journal. Acute Cardiovascular Care

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“…Moreover, based on the intravascular imaging techniques, elevated sUA is associated with changes in the contents of the atherosclerotic plaques, mostly regarding the larger dimensions of the lipidic plaque, higher lipidic and lower fibrotic content, with higher occurrence of plaque ruptures and red thrombi than in subjects with lower sUA [26][27][28][29]. Finally, the plaques in patients with elevated sUA levels have a significantly lower minimum vessel lumen area demonstrating a more significant extent of CAD.…”

Section: Discussionmentioning

confidence: 99%

Serum uric acid is an independent risk factor of worse mid- and long-term outcomes in patients with non-ST-segment elevation acute coronary syndromes

et al. 2021

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“…In fact, previous research described positive associations between sUA and several inflammatory markers, including C-reactive protein, interleukins, and TNF-α [30]. We previously reported that elevated uric acid, which possibly represents oxidative stress and vascular inflammation, was associated with coronary culprit lesion plaque rupture determined by OCT in patients with ACS [11]. In a previous study using integrated backscatter intravascular ultrasound, Ando et al [31] showed that sUA levels correlated with percent lipid volume at the culprit lesion in patients with coronary artery disease (among them, one-third had ACS).…”

Section: Discussionmentioning

confidence: 99%

“…OCT imaging of culprit lesions was performed using either a commercially available time-domain OCT (Model M3 Cardiology Imaging System, St. Jude Medical, Westford, MA, USA) or a frequency-domain OCT (C7XR system and the Dragonfly imaging catheter, St. Jude Medical). The OCT procedure has been reported previously [11, 16]. …”

Section: Methodsmentioning

confidence: 99%

“…To stratify ACS patients, several risk scorings for cardiac death after ACS have been devised, including age and traditional cardiovascular factors such as diabetes mellitus, dyslipidemia and hypertension, renal function, blood pressure, and heart rate [1-4]. Elevated serum uric acid (sUA) has been reported to predict the mortality of patients with ACS [5-11]; however, the clinical implication is insufficient because the sUA cut-off values to predict cardiac mortality are within the normal range (i.e., 6.0–7.0 mg/dL). Therefore, the impact of very high sUA levels on cardiac mortality in patients with ACS needs further examination.…”

Section: Introductionmentioning

confidence: 99%

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Impact of Accumulated Serum Uric Acid on Coronary Culprit Lesion Morphology Determined by Optical Coherence Tomography and Cardiac Outcomes in Patients with Acute Coronary Syndrome

Kobayashi

Asai

Tsurumi³

et al. 2018

Cardiology

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Objectives: We aimed to examine the relations of very high levels of serum uric acid (sUA) with features of culprit lesion plaque morphology determined by optical coherence tomography (OCT) and adverse clinical outcomes in patients with acute coronary syndrome (ACS). Methods: We retrospectively compared ACS patients according to sUA levels of > 8.0 mg/dL (n = 169), 7.1–8.0 mg/dL (n = 163), 6.1–7.0 mg/dL (n = 259), and ≤6.0 mg/dL (n = 717). Angiography and OCT findings were analyzed in patients with preintervention OCT and the 4 sUA groups (> 8.0 mg/dL, n = 61; 7.1–8.0 mg/dL, n = 72; 6.1–7.0 mg/dL, n = 131; and ≤6.0 mg/dL, n = 348) were compared. Results: Cardiogenic shock was more prevalent in ACS patients with sUA > 8.0 mg/dL (22% vs. 19% vs. 10% vs. 6%, p < 0.001). Plaque rupture was observed more prevalently by OCT in patients with sUA > 8.0 mg/dL (67% vs. 47% vs. 56% vs. 45%, p = 0.027). At the 2-year follow-up, Kaplan-Meier estimates showed higher cardiac mortality in patients with sUA > 8.0 mg/dL (25% vs. 12% vs. 5% vs. 5%, p < 0.001). After adjusting for traditional cardiovascular risk factors and creatinine levels, patients with sUA > 8.0 mg/dL showed a 4.5-fold increased risk in 2-year cardiac death by multivariate Cox proportional hazard analysis (hazard ratio 4.54, 95% confidence interval 2.98–6.91; p < 0.001). Conclusions: Very high sUA levels like > 8.0 mg/dL are the primary predictor of 2-year cardiac mortality and could partly be caused by adverse effects of accumulated sUA on plaque morphology in patients with ACS.

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Relation of Coronary Culprit Lesion Morphology Determined by Optical Coherence Tomography and Cardiac Outcomes to Serum Uric Acid Levels in Patients With Acute Coronary Syndrome

Cited by 13 publications

References 31 publications

The prognostic impact of the uric acid level in patients who require cardiovascular intensive care – is serum uric acid a surrogate biomarker for critical patients in the non-surgical intensive care unit?

The prognostic impact of the uric acid level in patients who require cardiovascular intensive care – is serum uric acid a surrogate biomarker for critical patients in the non-surgical intensive care unit?

Serum uric acid is an independent risk factor of worse mid- and long-term outcomes in patients with non-ST-segment elevation acute coronary syndromes

Impact of Accumulated Serum Uric Acid on Coronary Culprit Lesion Morphology Determined by Optical Coherence Tomography and Cardiac Outcomes in Patients with Acute Coronary Syndrome

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