Uric acid and mild renal impairment in patients with ST-elevation myocardial infarction
Chiara Lazzeri1, Serafina Valente, Marco Chiostri
1Intensive Cardiac Coronary Unit, Heart and Vessel Department, Azienda Ospedaliero-Universitaria Careggi , Florence , Italy.
Insights
Elevated uric acid (UA) in ST-elevation myocardial infarction (STEMI) patients with mild renal impairment may indicate disease severity but does not impact short or long-term mortality. Further research is needed to understand this association.
Area of Science:
- Cardiology
- Nephrology
- Biochemistry
Background:
- Mild renal impairment is a significant mortality risk factor in ST-elevation myocardial infarction (STEMI).
- Patients with renal impairment often exhibit decreased uric acid (UA) excretion, leading to elevated serum UA levels.
- The association between elevated UA and mortality in STEMI patients with mild renal impairment requires investigation.
Purpose of the Study:
- To assess the association between increased serum uric acid (UA) levels and mortality in ST-elevation myocardial infarction (STEMI) patients with mild renal impairment.
- To determine if elevated UA is linked to increased short-term and long-term mortality in this specific patient group.
Main Methods:
- A prospective study involving 578 STEMI patients with mild renal impairment.
- Assessment of whether elevated UA levels correlate with increased mortality during hospitalization and at 1-year follow-up.
Main Results:
- Patients in the highest UA tertile had a higher incidence of Killip class III-IV and lower ejection fraction (EF).
- The highest UA tertile was associated with lower eGFR, higher peak troponin I (Tn I), and higher NT-proBrain Natriuretic Peptide (NT-proBNP).
- No significant differences in short-term (ICCU stay) or long-term (1-year) mortality rates were observed among the UA tertiles.
Conclusions:
- Elevated UA levels in STEMI patients with mild renal impairment may serve as a marker for the severity of coronary artery disease.
- These UA levels identify patients with advanced age, greater hemodynamic derangement, and reduced renal function.
- Despite being a marker of disease severity, elevated UA did not predict short or long-term mortality in this cohort.
Aims:
Mild renal impairment (estimated GFR 60-89 ml/min/1.73 m(2)) is a strong independent risk factor for mortality in ST-elevation myocardial infarction (STEMI), and is submitted to mechanical revascularization. Patients with renal impairment have decreased excretion of uric acid (UA) and they are thus particularly prone to have elevated serum UA concentrations. This study was aimed at assessing the association between increased UA and mortality in STEMI patients with mild renal impairment.
Methods:
We prospectively assessed, in 578 STEMI patients with mild renal impairment, whether elevated UA levels are associated with increased mortality both in the short term and in the long term.
Results:
Patients in the highest UA tertile showed a higher incidence of Killip class III-IV (p = 0.003) and lower values of ejection fraction (EF) (p < 0.001). Lower values for estimated glomerular filtration rate (eGFR) at admission, nadir, and discharge were detected in the highest UA tertile, together with the highest values of peak troponin I (Tn I) (p = 0.002), and NT-proBrain Natriuretic Peptide [NT-proBNP] (p < 0.001). No difference was found in mortality rates (both during their stay in the intensive cardiac care unit [ICCU], and at the 1-year post-discharge follow-up) among the UA tertiles.
Conclusions:
The UA levels seem to serve as markers of the severity of coronary artery disease, since they identify a subset of patients characterized by an advanced age, more hemodynamic derangement, and reduced renal function. However, neither short nor long-term mortality was affected.
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