Cardiology Department, Hospital of San Juan de Alicante, San Juan De Alicante, Spain; Catedra de Medicina de Familia, Clinical Medicine Department, Miguel Hernandez University, San Juan de Alicante, Spain.
Cardiology Department, Hospital of San Juan de Alicante, San Juan De Alicante, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Hospital Clínico Universitario de Santiago de Compostela-SERGAS, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, Spain.
Atherosclerosis. 2018 Feb;269:229-235. doi: 10.1016/j.atherosclerosis.2018.01.017. Epub 2018 Jan 17.
Many studies have reported the independent association between uric acid and cardiovascular disease, its role as a risk predictor for outcomes in people with acute coronary syndrome remains controversial. This study aims to assess the association between hyperuricemia and medium/long-term clinical outcomes in people with acute coronary syndrome and determine whether adding hyperuricemia to the GRACE score improves its predictive capability.
This cohort study included patients admitted for acute coronary syndrome between 2008 and 2013. Outcomes were cardiovascular and total mortality, and major cardiovascular events. We used a multivariate model to adjust for potential confounding covariates and presented event rates with Kaplan-Meier curves. After adding hyperuricemia to the GRACE score, we compared scores from the reclassification table and the net reclassification improvement.
1119 participants were included and followed-up for a mean of 36 months. Multivariate models showed hyperuricemia was independently associated with higher cardiovascular mortality (HR:1.91; 95% CI:1.32-2.76; p < 0.01), higher all-cause mortality (HR:1.59; 95% CI:1.18-2.15; p < 0.01) and higher major cardiovascular event rates (HR:1.36; 95% CI:1.11-1.67; p < 0.01). The hyperuricemia addition to GRACE score led to reclassifying 26% of the participants, and net reclassification improvement was 34%. However, the area under the curve increase was 0.009 and not statistically significant (p > 0.05).
Hyperuricemia is associated with higher medium/long-term mortality and major cardiovascular event rates in patients following acute coronary syndrome. The addition of hyperuricemia to the GRACE score seems to improve risk classification but the discrimination of the new predictive model did not change. Hyperuricemic patients had higher all-cause mortality in medium and high-risk score categories.
许多研究报道尿酸与心血管疾病独立相关，但其作为急性冠状动脉综合征患者结局的风险预测因子的作用仍存在争议。本研究旨在评估急性冠状动脉综合征患者高尿酸血症与中/长期临床结局的关系，并确定将高尿酸血症加入 GRACE 评分是否能提高其预测能力。
本队列研究纳入了 2008 年至 2013 年间因急性冠状动脉综合征入院的患者。结局为心血管和全因死亡率以及主要心血管事件。我们使用多变量模型调整潜在的混杂协变量，并通过 Kaplan-Meier 曲线呈现事件发生率。在将高尿酸血症加入 GRACE 评分后，我们比较了重新分类表和净重新分类改善的评分。
共纳入 1119 名参与者，平均随访 36 个月。多变量模型显示，高尿酸血症与心血管死亡率升高（HR：1.91；95%CI：1.32-2.76；p<0.01）、全因死亡率升高（HR：1.59；95%CI：1.18-2.15；p<0.01）和主要心血管事件发生率升高（HR：1.36；95%CI：1.11-1.67；p<0.01）独立相关。将高尿酸血症加入 GRACE 评分后，重新分类了 26%的参与者，净重新分类改善为 34%。然而，曲线下面积增加仅为 0.009，且无统计学意义（p>0.05）。
高尿酸血症与急性冠状动脉综合征患者的中/长期死亡率和主要心血管事件发生率升高相关。将高尿酸血症加入 GRACE 评分似乎可以改善风险分类，但新预测模型的区分度没有改变。在中危和高危评分类别中，高尿酸血症患者的全因死亡率更高。
