Department of Cardiology, Takaoka City Hospital.
Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences.
Int Heart J. 2022 May 31;63(3):447-453. doi: 10.1536/ihj.21-764. Epub 2022 May 14.
This study aims to explore the associations between uric acid (UA) and long-term outcomes among patients with acute coronary syndrome (ACS). A total of 1068 consecutive patients with ACS who underwent percutaneous coronary intervention (PCI) were analyzed retrospectively. The patients were divided into 3 groups based on the levels of serum UA upon admission (bottom quintile, middle 3 quintiles, and top quintile). The primary endpoint was all-cause mortality. The patients in the higher UA groups were associated with younger age (71 ± 11 versus 68 ± 12 versus 67 ± 14 years; P < 0.05) and were more likely to be male (57.6 versus 76.9 versus 84.7%; P < 0.001). Furthermore, these patients had lower estimated glomerular filtration rates (83 ± 27 versus 74 ± 23 versus 59 ± 24 mL/minute/1.73 m; P < 0.001) and lower left ventricular ejection fractions (58 ± 14 versus 57 ± 14 versus 53 ± 15%; P < 0.001). During the median 4-year follow-up, there were 158 incidents of all-cause death. Patients in the top quintile, followed by patients in the bottom quintile, had greater all-cause mortality compared with patients in the middle quintile (16.5 versus 11.4 versus 23.8%; P < 0.001). When the middle of the 3 quintiles was assigned as the reference group, the adjusted hazard ratios for all-cause mortality for the top and bottom quintiles were 1.72 (95% confidence interval [CI] 1.16-2.53, P < 0.05) and 1.57 (95% CI 1.03-2.36, P < 0.05), respectively. These results demonstrate that UA levels upon admission in patients with ACS who underwent PCI exhibited a 'J-shaped' association with all-cause mortality.
这项研究旨在探讨尿酸（UA）与急性冠状动脉综合征（ACS）患者长期预后之间的关系。回顾性分析了 1068 例接受经皮冠状动脉介入治疗（PCI）的 ACS 连续患者。根据入院时血清 UA 水平将患者分为 3 组（bottom quintile，middle 3 quintiles 和 top quintile）。主要终点为全因死亡率。UA 水平较高的患者年龄较轻（71 ± 11 岁比 68 ± 12 岁比 67 ± 14 岁；P < 0.05），且更可能为男性（57.6%比 76.9%比 84.7%；P < 0.001）。此外，这些患者估算肾小球滤过率较低（83 ± 27 毫升/分钟/1.73 米比 74 ± 23 毫升/分钟/1.73 米比 59 ± 24 毫升/分钟/1.73 米；P < 0.001），左心室射血分数较低（58 ± 14 毫升比 57 ± 14 毫升比 53 ± 15 毫升；P < 0.001）。在中位 4 年随访期间，有 158 例发生全因死亡。与中间五分位组相比，五分位最高组和最低组的全因死亡率更高（16.5%比 11.4%比 23.8%；P < 0.001）。当将中间的 3 个五分位组作为参考组时，五分位最高组和最低组的全因死亡风险调整后 HR 分别为 1.72（95%CI 1.16-2.53，P < 0.05）和 1.57（95%CI 1.03-2.36，P < 0.05）。这些结果表明，PCI 治疗的 ACS 患者入院时的 UA 水平与全因死亡率呈“J 形”相关。
