Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan.
Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan.
Am J Cardiol. 2018 Jul 1;122(1):17-25. doi: 10.1016/j.amjcard.2018.03.022. Epub 2018 Mar 28.
The aims of the present study were to elucidate features of culprit lesion plaque morphology using optical coherence tomography (OCT) in relation to elevated serum uric acid (sUA) levels and to clarify the impact of sUA levels on adverse clinical outcomes in patients with acute coronary syndrome (ACS). Clinical data and outcomes were compared between ACS patients with sUA ≥6 mg/dl (high-sUA; n = 506) and sUA <6.0 mg/dl (low-sUA; n = 608). Angiography and OCT findings were analyzed in patients with preintervention OCT and compared between groups of high-sUA (n = 206) and low-sUA (n = 273). Patients with high-sUA were more frequently male (88% vs 74%, p <0.001), younger (median 65 years vs 67 years, p = 0.017), more obese (median body mass index; 24.3 kg/m vs 23.2 kg/m, p <0.001), and had a more frequent history of hypertension (72% vs 62%, p <0.001). ACS with lung congestion or cardiogenic shock was more prevalent in patients with high-sUA (30% vs 13%, p <0.001). Plaque rupture (54% vs 42%, p = 0.021) and red thrombi (55% vs 41%, p = 0.010) were more prevalently observed by OCT in patients with high-sUA. Kaplan-Meier estimate survival curves showed that the 2-year cardiac mortality was higher in patients with high-sUA (12.1% vs 4.2%, p <0.001). The multivariate Cox proportional hazard analysis showed that sUA values independently and significantly predicted cardiac death within 2 years (hazard ratio 1.41 [95% confidence interval 1.26 to 1.57], p <0.001). In conclusion, sUA levels are associated with culprit lesion coronary plaque morphology and raised sUA levels affect cardiovascular mortality after adjusting for several cardiovascular risk factors.
本研究的目的是通过光学相干断层扫描（OCT）阐明与血清尿酸（sUA）水平升高相关的罪犯病变斑块形态学特征，并阐明 sUA 水平对急性冠状动脉综合征（ACS）患者不良临床结局的影响。将 sUA≥6mg/dl（高 sUA；n=506）和 sUA<6.0mg/dl（低 sUA；n=608）的 ACS 患者的临床数据和结局进行比较。对有预介入 OCT 的患者进行血管造影和 OCT 检查，并对高 sUA 组（n=206）和低 sUA 组（n=273）进行比较。高 sUA 患者更常为男性（88%比 74%，p<0.001），更年轻（中位数 65 岁比 67 岁，p=0.017），更肥胖（中位数体重指数；24.3kg/m 比 23.2kg/m，p<0.001），且高血压病史更常见（72%比 62%，p<0.001）。ACS 合并肺充血或心源性休克在高 sUA 患者中更为常见（30%比 13%，p<0.001）。OCT 显示，高 sUA 患者斑块破裂（54%比 42%，p=0.021）和红色血栓（55%比 41%，p=0.010）更为常见。Kaplan-Meier 估计生存曲线显示，高 sUA 患者 2 年内心脏死亡率更高（12.1%比 4.2%，p<0.001）。多变量 Cox 比例风险分析显示，sUA 值独立且显著预测 2 年内的心脏死亡（风险比 1.41[95%置信区间 1.26 至 1.57]，p<0.001）。总之，sUA 水平与罪犯病变冠状动脉斑块形态有关，在调整了几个心血管危险因素后，升高的 sUA 水平会影响心血管死亡率。
