Kim Soohyun, Hwang Byung-Hee, Lee Kwan Yong, Kim Chan Jun, Choo Eun-Ho, Lim Sungmin, Kim Jin-Jin, Choi Ik Jun, Park Mahn-Won, Oh Gyu Chul, Yoo Ki Dong, Chung Wook Sung, Ahn Youngkeun, Jeong Myung Ho, Chang Kiyuk
Cardiovascular Center and Cardiology Division, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul 06591, Korea.
Cardiovascular Center and Cardiology Division, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Uijeonbu 11765, Korea.
J Clin Med. 2022 Sep 21;11(19):5531. doi: 10.3390/jcm11195531.
The current study aimed to investigate the association between serum UA levels and the mortality rate of AMI patients. We analyzed 5888 patients with successfully revascularized AMI (mean age: 64.0 ± 12.7 years). The subjects were divided into the high UA group (uric acid >6.5 mg/dL for males, >5.8 mg/dL for females) or the normal UA group based on initial serum UA level measured at admission. The primary outcome was all-cause mortality. A total of 4141 (70.3%) and 1747 (29.7%) patients were classified into the normal UA group and high UA groups, respectively. Over a median follow-up of 5.02 (3.07, 7.55) years, 929 (21.5%) and 532 (34.1%) patients died in each group. Cox regression analysis identified high UA levels as an independent predictor of all-cause mortality (unadjusted hazard ratio (HR) 1.69 [95% CI 1.52−1.88]; p < 0.001, adjusted HR 1.18 [95% CI: 1.05−1.32]; p = 0.005). The results were consistent after propensity-score matching and inverse probability weighting to adjust for baseline differences. The predictive accuracies of conventional clinical factor discrimination and reclassification were significantly improved upon the addition of hyperuricemia (C-index 0.788 [95% CI 0.775−0.801]; p = 0.005, IDI 0.004 [95% CI 0.002−0.006]; p < 0.001, NRI 0.263 [95% CI 0.208−0.318]; p < 0.001).
本研究旨在探讨血清尿酸（UA）水平与急性心肌梗死（AMI）患者死亡率之间的关联。我们分析了5888例成功进行血管重建的AMI患者（平均年龄：64.0±12.7岁）。根据入院时测定的初始血清UA水平，将受试者分为高UA组（男性尿酸>6.5mg/dL，女性>5.8mg/dL）或正常UA组。主要结局为全因死亡率。分别有4141例（70.3%）和1747例（29.7%）患者被归入正常UA组和高UA组。在中位随访5.02（3.07，7.55）年期间，每组分别有929例（21.5%）和532例（34.1%）患者死亡。Cox回归分析确定高UA水平是全因死亡率的独立预测因素（未调整风险比（HR）1.69[95%CI 1.52−1.88]；p<0.001，调整后HR 1.18[95%CI：1.05−1.32]；p = 0.005）。在进行倾向评分匹配和逆概率加权以调整基线差异后，结果一致。在加入高尿酸血症后，传统临床因素鉴别和重新分类的预测准确性显著提高（C指数0.788[95%CI 0.775−0.801]；p = 0.005，综合判别改善指数（IDI）0.004[95%CI 0.002−0.006]；p<0.001，净重新分类指数（NRI）0.263[95%CI 0.208−0.318]；p<0.001）。
