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Long-term prognostic role of uric acid in patients with ST-elevation myocardial infarction and renal dysfunction

Chiara Lazzeri1, Serafina Valente, Marco Chiostri

  • 1aIntensive Cardiac Coronary Unit, Heart and Vessel Department, Azienda Ospedaliero-Universitaria Careggi bDepartment of Experimental and Clinical Medicine, University of Florence, AOU Careggi, Fondazione Don Carlo Gnocchi IRCCS, Florence, Italy.

Journal of Cardiovascular Medicine (Hagerstown, Md.)
|March 26, 2015
PubMed

Insights

In patients with ST-elevation myocardial infarction and renal dysfunction, elevated uric acid levels predict higher mortality. This finding identifies a high-risk group for bleeding and acute kidney injury, suggesting uric acid as a prognostic factor.

Area of Science:

  • Cardiology
  • Nephrology
  • Biochemistry

Background:

  • Renal impairment reduces uric acid excretion, leading to elevated serum concentrations.
  • Limited data exist on the long-term prognostic value of uric acid in ST-elevation myocardial infarction (STEMI) patients with renal dysfunction undergoing percutaneous coronary intervention (PCI).

Purpose of the Study:

  • To prospectively assess the association between uric acid levels and 1-year mortality in STEMI patients with renal dysfunction treated with PCI.
  • To identify if uric acid predicts increased risk of bleeding and acute kidney injury in this patient population.

Main Methods:

  • Prospective study of 329 patients with STEMI and estimated glomerular filtration rate <60 ml/min/1.73 m² who underwent PCI.
  • Serum uric acid levels were measured, and patients were analyzed by tertiles.
  • 1-year postdischarge mortality, bleeding incidence, and acute kidney injury were assessed.
  • Cox regression analysis was used to determine independent predictors of mortality.

Main Results:

  • Patients in the highest uric acid tertile had higher BMI, hypertension, and comorbidities.
  • The highest incidence of bleeding and acute kidney injury was observed in the highest uric acid tertile (P=0.011 and P<0.001, respectively).
  • The highest mortality rate at 1-year follow-up was seen in the highest uric acid tertile (P=0.008).
  • Uric acid was an independent predictor of 1-year mortality (HR 1.26, P=0.011).

Conclusions:

  • In STEMI patients with renal dysfunction treated with PCI, elevated uric acid identifies a subset at higher risk for bleeding and acute kidney injury.
  • Increased uric acid is an independent prognostic risk factor for 1-year mortality in this cohort.
  • Further studies in larger cohorts are needed to confirm findings and evaluate the benefit of lowering uric acid.

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