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Serum uric acid level predicts adverse outcomes after myocardial revascularization or cardiac valve surgery
Davide Lazzeroni1, Matteo Bini2, Umberto Camaiora1
11 IRCCS Fondazione Don C Gnocchi, Milan, Italy.
Insights
High serum uric acid levels are a significant predictor of mortality and adverse cardiovascular events in patients after heart surgery. Elevated levels indicate a poorer prognosis, even after accounting for other risk factors.
Area of Science:
- Cardiology
- Clinical Biochemistry
Background:
- High serum uric acid is linked to adverse cardiovascular outcomes.
- Its prognostic role in patients post-myocardial revascularization or valve surgery requires evaluation.
Purpose of the Study:
- To assess the prognostic significance of serum uric acid levels in patients undergoing cardiac rehabilitation.
- To determine the association between elevated uric acid and mortality or major adverse events.
Main Methods:
- An observational prospective cohort study of 1440 patients.
- Follow-up duration of 50 ± 17 months.
- Serum uric acid levels measured, with primary endpoints of overall and cardiovascular mortality, and secondary endpoints of major adverse cardiac and cerebrovascular events.
Main Results:
- Elevated serum uric acid (≥360 µmol/l) was found in 19% of patients.
- Significantly higher overall mortality (HR=2.1), cardiovascular mortality (HR=2.0), and MACE (HR=1.5) in patients with elevated uric acid.
- These associations remained significant after adjusting for multiple clinical and demographic factors.
Conclusions:
- Serum uric acid levels serve as an independent predictor of mortality and adverse cardiovascular outcomes.
- These findings are relevant for patients who have undergone myocardial revascularization and/or cardiac valve surgery.
- Monitoring uric acid may aid in risk stratification for cardiac patients.
Abstract:
Background High levels of serum uric acid have been associated with adverse outcomes in cardiovascular diseases such as myocardial infarction and heart failure. The aim of the current study was to evaluate the prognostic role of serum uric acid levels in patients undergoing cardiac rehabilitation after myocardial revascularization and/or cardiac valve surgery. Design We performed an observational prospective cohort study. Methods The study included 1440 patients with available serum uric acid levels, prospectively followed for 50 ± 17 months. Mean age was 67 ± 11 years; 781 patients (54%) underwent myocardial revascularization, 474 (33%) cardiac valve surgery and 185 (13%) valve-plus-coronary artery by-pass graft surgery. The primary endpoints were overall and cardiovascular mortality while secondary end-points were combined major adverse cardiac and cerebrovascular events. Results Serum uric acid level mean values were 286 ± 95 µmol/l and elevated serum uric acid levels (≥360 µmol/l or 6 mg/dl) were found in 275 patients (19%). Overall mortality (hazard ratio = 2.1; 95% confidence interval: 1.5-3.0; p < 0.001), cardiovascular mortality (hazard ratio = 2.0; 95% confidence interval: 1.2-3.2; p = 0.004) and major adverse cardiac and cerebrovascular events rate (hazard ratio = 1.5; 95% confidence interval: 1.0-2.0; p = 0.019) were significantly higher in patients with elevated serum uric acid levels, even after adjustment for age, gender, arterial hypertension, diabetes, glomerular filtration rate, atrial fibrillation and medical therapy. Moreover, strong positive correlations between serum uric acid level and probability of overall mortality ( p < 0.001), cardiovascular mortality ( p < 0.001) and major adverse cardiac and cerebrovascular events ( p = 0.003) were found. Conclusions Serum uric acid levels predict mortality and adverse cardiovascular outcome in patients undergoing myocardial revascularization and/or cardiac valve surgery even after the adjustment for age, gender, arterial hypertension, diabetes, glomerular filtration rate and medical therapy.
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