engleski

Uric acid as a predictive biomarker of 30-day outcomes after acute myocardial infarction: a retrospective cohort study

Purpose: We performed a study to evaluate the accuracy of admission UA serum level as a predictor of major adverse cardiac events (MACE) in the context of acute myocardial infarction (AMI). Methods: We evaluated results of cohort of 210 patients hospitalized in our center from January till December 2010 for ischemic chest discomfort within first 12 hours from the onset of symptoms and diagnosed with either non-ST segment elevation MI or ST segment elevation MI. None of the patients has been previously diagnosed with CAD. Exclusion criteria included previously documented elevated UA levels, chronic kidney disease, malignancy and chronic alcoholism. Follow up was achieved by means of standard hospital database and chart reviews and telephone calls at 30th day post admission. Measured MACE conditions were acute heart failure, new symptoms of CAD that required treatment, and cardiac death. The ROC curve analyses was used in order to determine optimal UA gender specific cut-off values for prediction of MACE during 30 days of follow-up. Cox proportional hazards regression model was employed to calculated the risk of adverse outcomes with elevated UA after adjusting for sex, age, body mass index, hypertension, diabetes, hyperlipidaemia, smoking, diuretics, angiotensin converting enzyme inhibitors and statins. Results: The mean age was 63 years with 20% of patient at least 75 years old. Women accounted for 26.4% of the study population. The index diagnosis was STEMI in 80.5% and NSTEMI in 19.5%. Most patients underwent PCI (75%) during the index hospitalization (mean days in hospital 7.2). The mean left ventricular EF was 45.6%, Killip class II-IV in 19.0% patients, eGFR median value was 87.4 ml/min/1.73 m2 with 9.5% lower than 60 ml/mi/1.73 m2. Patients were classified into two subgroups, having serum UA level under or above the gender specific ROC determined cut off value (360 μmol/l for men and 309 μmol/l for women). The incidence of total MACE was 35.2% with significant differences between two groups 23% vs. 49% p < 0.001 (acute cardiac failure 14% vs. 31%, p = 0.004, new symptoms of CAD 6% vs. 9%, p=0.298 and cardiac death 4% vs. 9%, p = 0.149). The instantaneus relative risk of MACE during the 30-day period with respect to the UA level measured at admittance to the hospital is 2.52 with 95% CI 1.57- 4.06. Conclusion: Our results suggest that the patient having serum UA at admittance above the gender specified value is more likely to develop AMI related complications in 30-days period therefore elevated serum uric acid level can be considered a reliable marker for predicting adverse events in AMI.

uric acid; myocardial infarction; outcomes; prognosis

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