engleski

Uric acid as a predictor of myocardial infarction course and outcome

The relationship between elevated serum uric acid (UA) and cardiovascular (CV) diseases is still incompletely investigated. Elevated UA is often associated with independent risk factors for CV diseases, such as arterial hypertension (AH), diabetes mellitus (DM), hyperlipidemia (HLP) and obesity. We investigated the predictive value of elevated UA in patients with acute myocardial infarction (AMI), regarding AMI course and outcome. 289 patients (141 or 68.8% male, mean age 66.2+/-12.1 years) with AMI admitted to our Coronary Care Unit during the year 2006. were analysed. Patients with elevated UA (>410 umol/L) (n=84, 29.1%) were compaired with those having normal UA levels, according to age sex CV risk factors (AH, DM, HLP, smoking). In both groups the frequency of AIM with and without ST elevation (STEMI and NSTEMI) was analysed, as well as the average peak CK-MB values. ROC curve was used to analyse relationship between UA values and acute heart failure (HF) occurrence (Killip II-IV), as well as for early mortality within the first month. Patients with elevated UA (mean value 525+/-71.1 umol/L) more often developed HF (Killip II: 31.0% vs. 11.7%, p=0.0002 ; Killip III-IV:22.6% vs. 6.3%, p=0.0001). They also had higher early mortality rate (16.7% vs. 7.8%, p=0.041). The two groups did not differ significantly in other CV risk factors (AH - 56, 0% vs. 55.6% ; DM - 26.2% vs. 23.4 % ; HLP - 50.0%vs. 55.1% ; smoking - 41.5% vs. 32.1%). No significant difference existed in frequency of STEMI (77.6% vs. 72.6%) and NSTEMI (22.4% vs. 27.4%), as well as in the average peak CK-MB values (167.9+/-181.6 vs. 152.7+/-163.6 umol/L). ROC curve analysis showed elevated UA to be a good predictor of bad outcome. Cut-off value was 407 umol/L ; AUC 0.700 ; SE 0.036 (95% CI=0.643-0.753) ; odds ratio 4.85 (95% CI=2.275-8.462). Sensitivity of the test was 54.3% and specificity was 80.8%. In our AIM patients elevated UA was significantly associated with acute heart failure and death. Other CV risk factors did not influence these results. Elevated UA is a good predictpr of increased risk in patients with AMI.

uric acid; cardiovascular diseases; myocardial infarction

nije evidentirano