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Atherosclerosis. 2018 Feb;269:229-235. doi: 10.1016/j.atherosclerosis.2018.01.017. Epub 2018 Jan 17.

Hyperuricemia as a prognostic factor after acute coronary syndrome.

Author information

1
Cardiology Department, Hospital of San Juan de Alicante, San Juan De Alicante, Spain; Catedra de Medicina de Familia, Clinical Medicine Department, Miguel Hernandez University, San Juan de Alicante, Spain.
2
Cardiology Department, Hospital of San Juan de Alicante, San Juan De Alicante, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Hospital Clínico Universitario de Santiago de Compostela-SERGAS, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, Spain. Electronic address: acorderofort@gmail.com.
3
Catedra de Medicina de Familia, Clinical Medicine Department, Miguel Hernandez University, San Juan de Alicante, Spain.
4
Cardiology Department, Hospital of San Juan de Alicante, San Juan De Alicante, Spain; Clinical Medicine Department, Miguel Hernandez University, San Juan de Alicante, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Fundación para la Investigacion del Hospital Clínico de la Comunidad Valenciana (Fundación INCLIVA), Valencia, Spain.
5
Cardiology Department, Hospital of San Juan de Alicante, San Juan De Alicante, Spain.

Abstract

BACKGROUND AND AIMS:

Many studies have reported the independent association between uric acid and cardiovascular disease, its role as a risk predictor for outcomes in people with acute coronary syndrome remains controversial. This study aims to assess the association between hyperuricemia and medium/long-term clinical outcomes in people with acute coronary syndrome and determine whether adding hyperuricemia to the GRACE score improves its predictive capability.

METHODS:

This cohort study included patients admitted for acute coronary syndrome between 2008 and 2013. Outcomes were cardiovascular and total mortality, and major cardiovascular events. We used a multivariate model to adjust for potential confounding covariates and presented event rates with Kaplan-Meier curves. After adding hyperuricemia to the GRACE score, we compared scores from the reclassification table and the net reclassification improvement.

RESULTS:

1119 participants were included and followed-up for a mean of 36 months. Multivariate models showed hyperuricemia was independently associated with higher cardiovascular mortality (HR:1.91; 95% CI:1.32-2.76; p < 0.01), higher all-cause mortality (HR:1.59; 95% CI:1.18-2.15; p < 0.01) and higher major cardiovascular event rates (HR:1.36; 95% CI:1.11-1.67; p < 0.01). The hyperuricemia addition to GRACE score led to reclassifying 26% of the participants, and net reclassification improvement was 34%. However, the area under the curve increase was 0.009 and not statistically significant (p > 0.05).

CONCLUSIONS:

Hyperuricemia is associated with higher medium/long-term mortality and major cardiovascular event rates in patients following acute coronary syndrome. The addition of hyperuricemia to the GRACE score seems to improve risk classification but the discrimination of the new predictive model did not change. Hyperuricemic patients had higher all-cause mortality in medium and high-risk score categories.

KEYWORDS:

Acute coronary syndrome; Cardiology; Hyperuricemia; Risk factors; Uric acid

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