Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
Graduate Institute of Natural Products, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan.
Clin Pharmacol Ther. 2022 Mar;111(3):655-663. doi: 10.1002/cpt.2473. Epub 2021 Nov 17.
The role of urate-lowering therapy (ULT) for the primary prevention of cardiovascular (CV) events has been widely discussed, but its evidence for the secondary prevention of myocardial infarction (MI) is limited. Therefore, we conduct a population-based, propensity score-matched cohort study to investigate the CV outcomes among patients with post-MI with and without ULT. A total of 19,042 newly diagnosed in-hospital patients with MI were selected using the Taiwan National Health Insurance Database between January 1, 2005, and December 31, 2016. After 1:1 propensity score matching with covariates, patients with MI with (n = 963) and without (n = 963) ULT were selected for further analysis. The primary outcome was the all-cause mortality and the secondary outcomes were composite CV outcomes, including hospitalization for recurrent MI, stroke, heart failure, and cardiac arrhythmias. ULT users were associated with lower all-cause mortality (adjusted hazard ratio (adjHR), 0.67; 95% confidence interval (CI), 0.51-0.87) compared to the ULT nonusers. In addition, ULT users had a significantly lower risk of recurrent MI, which needed revascularization by percutaneous coronary intervention or coronary artery bypass grafting (adjHR, 0.67; 95% CI, 0.53-0.86) than the ULT nonusers. The primary and secondary outcomes were not different between patients with post-MI who received uricosuric agents and xanthine oxidase inhibitors. The anti-inflammatory effect of ULT plays an essential role in MI management. From a real-world setting, this study shows that ULT is associated with the lower risk of all-cause mortality in patients with post-MI. In addition, the result shows the possible lower incidence of repeat revascularization procedures in the ULT users.
降尿酸治疗（ULT）在心血管（CV）事件一级预防中的作用已被广泛讨论，但在心肌梗死（MI）二级预防中的证据有限。因此，我们进行了一项基于人群的、倾向评分匹配队列研究，以调查 MI 后有和没有 ULT 的患者的 CV 结局。我们使用台湾全民健康保险数据库，从 2005 年 1 月 1 日至 2016 年 12 月 31 日，共选择了 19042 名新诊断的住院 MI 患者。在对协变量进行 1:1 倾向评分匹配后，选择了接受 ULT（n=963）和未接受 ULT（n=963）的 MI 患者进行进一步分析。主要结局是全因死亡率，次要结局是复合 CV 结局，包括因 MI、中风、心力衰竭和心律失常再次住院。与未接受 ULT 的患者相比，ULT 使用者的全因死亡率较低（调整后的危险比（adjHR），0.67；95%置信区间（CI），0.51-0.87）。此外，ULT 使用者发生需要经皮冠状动脉介入或冠状动脉旁路移植术（adjHR，0.67；95%CI，0.53-0.86）再血管化的 MI 复发风险显著降低。与接受尿酸排泄剂和黄嘌呤氧化酶抑制剂的 MI 后患者相比，主要和次要结局无差异。ULT 的抗炎作用在 MI 管理中起着重要作用。从真实世界的角度来看，本研究表明 ULT 与 MI 后患者的全因死亡率降低相关。此外，结果显示 ULT 使用者可能重复血管重建手术的发生率较低。
