双能 CT 检查中尿酸对伴或不伴阻塞性冠状动脉疾病患者的预后意义。
Prognostic Significance of Uric Acid in Patients with Obstructive and Nonobstructive Coronary Artery Disease Undergoing D-SPECT.
机构信息
Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China.
Department of Cardiology, Shanghai Tenth People's Hospital Chongming Branch, Shanghai, People's Republic of China.
出版信息
Clin Interv Aging. 2021 Nov 16;16:1955-1965. doi: 10.2147/CIA.S339600. eCollection 2021.
PURPOSE
The association of serum uric acid (SUA) levels with cardiovascular outcomes in patients with coronary artery disease (CAD) has been extensively studied and yielded conflicting results. We aimed to investigate whether the severity of coronary stenosis and ischemia influences the prognostic impact of SUA levels in patients with CAD undergoing D-SPECT.
PATIENTS AND METHODS
This study consecutively included patients who were admitted for CAD in Shanghai Tenth People's Hospital between June 2014 and August 2018, had complete SUA data and underwent both coronary angiography and D-SPECT within 3 months. Hyperuricemia was defined as an SUA level of >7 mg/dL in men and >6 mg/dL in women. The primary outcome was major adverse cardiovascular events (MACE), defined as a composite of cardiac death, unplanned coronary revascularization, nonfatal myocardial infarction, ischemic stroke, heart failure, and angina-related hospitalization.
RESULTS
A total of 695 patients were included, of whom 432 (62.2%) presented with obstructive CAD and 117 (16.8%) had hyperuricemia. During a median follow-up of 26 months, the incidence rates of MACE in patients with hyperuricemia and normouricemia were 15.2% and 21.1%, respectively. After a multivariable adjustment, hyperuricemia was significantly associated with an increased risk of MACE (HR: 1.39, 95% CI: 1.03-1.87, = 0.033) when compared with normouricemia. When repeating the primary analysis in patients with and without obstructive CAD, we showed that hyperuricemia was independently associated with an 80% increased risk of MACE among patients with nonobstructive CAD (HR: 1.80, 95% CI: 1.04-3.11, = 0.035), while such a significant association was not found among those with obstructive CAD (HR: 1.18, 95% CI: 0.82-1.72, = 0.373). Moreover, we uncovered a U-shaped and linear trajectory of SUA levels with MACE in the obstructive and nonobstructive CAD, respectively. The sex-specific analysis showed that the adverse impact of hyperuricemia was only pronounced in males (HR: 1.73, 95% CI: 1.18-2.53, = 0.005) but not in females (HR: 0.98, 95% CI: 0.57-1.66, = 0.933).
CONCLUSION
Hyperuricemia is significantly associated with increased risk of MACE in the nonobstructive CAD rather than in the obstructive CAD.
目的
血清尿酸（SUA）水平与冠状动脉疾病（CAD）患者心血管结局的关系已被广泛研究，但结果存在争议。本研究旨在探讨在接受 D-SPECT 的 CAD 患者中，冠状动脉狭窄和缺血的严重程度是否会影响 SUA 水平的预后影响。
方法
本研究连续纳入 2014 年 6 月至 2018 年 8 月期间在上海第十人民医院因 CAD 住院的患者，这些患者具有完整的 SUA 数据，并在 3 个月内同时接受了冠状动脉造影和 D-SPECT。高尿酸血症定义为男性 SUA 水平>7mg/dL，女性>6mg/dL。主要心血管不良事件（MACE）定义为心脏死亡、非计划性冠状动脉血运重建、非致死性心肌梗死、缺血性卒、心力衰竭和与心绞痛相关的住院的复合终点。
结果
共纳入 695 例患者，其中 432 例（62.2%）存在阻塞性 CAD，117 例（16.8%）患有高尿酸血症。在中位数为 26 个月的随访期间，高尿酸血症和正常尿酸血症患者的 MACE 发生率分别为 15.2%和 21.1%。在多变量调整后，与正常尿酸血症相比，高尿酸血症与 MACE 风险增加显著相关（HR：1.39，95%CI：1.03-1.87，=0.033）。当在有和无阻塞性 CAD 的患者中重复主要分析时，我们表明高尿酸血症与非阻塞性 CAD 患者 MACE 风险增加 80%相关（HR：1.80，95%CI：1.04-3.11，=0.035），而在阻塞性 CAD 患者中未发现这种显著相关性（HR：1.18，95%CI：0.82-1.72，=0.373）。此外，我们发现 SUA 水平与 MACE 之间存在 U 形和线性轨迹，分别在阻塞性和非阻塞性 CAD 中。性别特异性分析表明，高尿酸血症的不良影响仅在男性中显著（HR：1.73，95%CI：1.18-2.53，=0.005），而在女性中不显著（HR：0.98，95%CI：0.57-1.66，=0.933）。
结论
高尿酸血症与非阻塞性 CAD 而非阻塞性 CAD 患者的 MACE 风险增加显著相关。
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