Tsai Tzu-Hsien, Chen Yung-Lung, Chen Shyh-Ming, Yang Cheng-Hsu, Fang Chih-Yuan, Hsieh Yuan-Kai, Wu Chiung-Jen, Yip Hon-Kan, Hang Chi-Ling, Fu Morgan, Chen Mien-Cheng
Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital - Kaohsiung Medical Center, Chang Gung University College of Medicine, Niaosong Township, Kaohsiung County 833, Taiwan (R.O.C.).
Chang Gung Med J. 2009 Nov-Dec;32(6):605-13.
The aim of this study is to investigate the impact of uric acid on clinical outcomes in patients with angiographically proven coronary artery disease.
Six hundred and forty seven consecutive patients with angiographically proven significant coronary artery disease were enrolled in this retrospective study. Patients were assigned to serum uric acid level >or= 6.4 mg/dL and < 6.4 mg/dL groups based on baseline fasting uric acid levels and determined by a receiver operating characteristic curve. The mean follow-up duration was 4.6 +/- 1.1 years after coronary angiography. The primary endpoints were all cause mortality and death from cardiovascular disease.
The five-year survival rates for patients free from all-cause mortality with levels of uric acid >or= 6.4 mg/dL and < 6.4 mg/dL were 82% and 92% respectively (p < 0.0001). Five-year survival rates for patients free from cardiovascular mortality with levels of uric acid uric acid >or= 6.4 mg/dL and < 6.4 mg/dL were 91% and 97% respectively (p = 0.003). Multivariate Cox regression analysis showed that serum uric acid was an independent predictor of all-cause death (p = 0.01) but was not an independent predictor of cardiovascular mortality (p = 0.063) after adjusting for multi-vessel coronary artery disease, chronic renal insufficiency and a left ventricular ejection fraction < 40%.
After multivariate adjustment, the fasting serum uric acid level was an independent predictor of all-cause mortality, but probably not an independent predictor of cardiovascular mortality in patients with angiographically proven coronary artery disease.
本研究旨在探讨尿酸对经血管造影证实患有冠状动脉疾病患者临床结局的影响。
本回顾性研究纳入了647例经血管造影证实患有严重冠状动脉疾病的连续患者。根据基线空腹尿酸水平，通过受试者工作特征曲线确定，将患者分为血清尿酸水平≥6.4mg/dL组和<6.4mg/dL组。冠状动脉造影术后的平均随访时间为4.6±1.1年。主要终点为全因死亡率和心血管疾病死亡。
尿酸水平≥6.4mg/dL和<6.4mg/dL的无全因死亡率患者的五年生存率分别为82%和92%（p<0.0001）。尿酸水平≥6.4mg/dL和<6.4mg/dL的无心血管死亡率患者的五年生存率分别为91%和97%（p = 0.003）。多因素Cox回归分析显示，在调整多支冠状动脉疾病、慢性肾功能不全和左心室射血分数<40%后，血清尿酸是全因死亡的独立预测因素（p = 0.01），但不是心血管死亡率的独立预测因素（p = 0.063）。
多因素调整后，空腹血清尿酸水平是经血管造影证实患有冠状动脉疾病患者全因死亡率的独立预测因素，但可能不是心血管死亡率的独立预测因素。
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