Li Yifan, Sang Tiantian, Lv Naqiang, Liu Jinxing, Gu Yingzhen, Han Xiaorong, Zhang Wei, Dang Aimin
Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Geriatrics, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China.
Ann Med. 2025 Dec;57(1):2445200. doi: 10.1080/07853890.2024.2445200. Epub 2024 Dec 24.
Uric acid (UA) plays an important role in cardiovascular diseases, yet its implications in elderly patients remains incompletely understood. This study aimed to explore the impact of UA on the prognosis in advanced-age patients with acute coronary syndrome (ACS).
We included 526 patients aged 80 and older who were diagnosed with ACS. The UA levels were measured at admission, and patients were divided into four groups based on quartiles of UA levels. Major adverse cardiovascular events (MACE) during follow-up were recorded.
The median UA level was 344.09 μmol/L, while the median follow-up duration was 64 months. Kaplan-Meier curves demonstrated a higher cumulative incidence of MACE during long-term follow-up in the Q4 group (Log-rank < 0.05). Cox regression analysis revealed an independent correlation between UA levels and an increased risk of MACE (HR 1.002, 95%CI 1.000-1.003, = 0.021). The ROC curve indicated that the optimal UA value for predicting MACE was 324.25 μmol/L. After matching through PSM, the MACE-free survival rate was lower in both hyperuricemia group (UA> 420.00 μmol/L) and high UA group (324.25 μmol/L < UA≤ 420.00 μmol/L) compared to the control group. Both hyperuricemia and high UA levels were independent risk factors for long-term MACE in advanced-age ACS patients, with HR values of 1.546 (1.049-2.280, = 0.028) and 1.491 (1.011-2.198, = 0.044), respectively.
Elevated UA levels were identified as independent risk factors for MACE in elderly patients with ACS. The optimal predictive value of UA for poor cardiovascular prognosis was significantly lower than the traditional definition of hyperuricemia.
尿酸（UA）在心血管疾病中起重要作用，但其在老年患者中的影响仍未完全明确。本研究旨在探讨UA对高龄急性冠状动脉综合征（ACS）患者预后的影响。
我们纳入了526例年龄在80岁及以上且被诊断为ACS的患者。入院时测量UA水平，并根据UA水平的四分位数将患者分为四组。记录随访期间的主要不良心血管事件（MACE）。
UA中位数水平为344.09μmol/L，中位随访时间为64个月。Kaplan-Meier曲线显示，在长期随访中，Q4组MACE的累积发生率更高（对数秩检验<0.05）。Cox回归分析显示，UA水平与MACE风险增加之间存在独立相关性（HR 1.002，95%CI 1.000-1.003，P = 0.021）。ROC曲线表明，预测MACE的最佳UA值为324.25μmol/L。通过倾向评分匹配（PSM）后，高尿酸血症组（UA>420.00μmol/L）和高UA组（324.25μmol/L<UA≤420.00μmol/L）的无MACE生存率均低于对照组。高尿酸血症和高UA水平均为高龄ACS患者长期发生MACE的独立危险因素，HR值分别为1.546（1.049-2.280，P = 0.028）和1.491（1.011-2.198，P = 0.044）。
UA水平升高被确定为老年ACS患者发生MACE的独立危险因素。UA对不良心血管预后的最佳预测值显著低于高尿酸血症的传统定义。
