Highlights
- •Data on the role of Uric Acid (UA) as a determining factor of Heart Failure related issue in Acute Coronary Syndrome (ACS) patients are scanty.
- •UA was confirmed to be significantly associated with Acute Heart Failure, Cardiogenic Shock, Non Invasive Ventilation and Ejection Fraction in ACS patients.
- •Evaluation of UA in ACS patients could help to identify the one with the worst heart failure related outcomes.
Abstract
We focused on the role of Uric Acid (UA) as a possible determinant of Heart Failure
(HF) related issues in Acute Coronary Syndromes (ACS) patients. Main outcomes were
acute HF and cardiogenic shock at admission, secondary outcomes were the use of Non
Invasive Ventilation (NIV) and the admission Left Ventricular Ejection Fraction (LVEF).
We consecutively enrolled 1269 ACS patients admitted to the cardiological Intensive
Care Unit of the Niguarda and San Paolo hospitals (Milan, Italy) from June 2016 to
June 2019. Median age was 68 (first-third quartile 59–77) years and males were 970
(76%). All the evaluated outcomes occurred more frequently in the hyperuricemic subjects
(UA higher than 6 mg/dL for females and 7 mg/dL for males, n = 292): acute HF 35.8 vs 11.1% (p < 0.0001), cardiogenic shock 10 vs 3.1% (p < 0.0001), NIV 24.1 vs 5.1% (p < 0.0001) and lower admission LVEF (42.9±12.8 vs 49.6±9.9, p < 0.0001). By multivariable analyses, UA was confirmed to be significantly associated
with all the outcomes with the following Odds Ratio (OR): acute HF OR = 1.119; 95%
CI 1.019;1.229; cardiogenic shock OR = 1.157; 95% CI 1.001;1.337; NIV use OR = 1.208;
95% CI 1.078;1.354; LVEF β = -0.999; 95% CI -1.413;-0.586. We found a significant
association between UA and acute HF, cardiogenic shock, NIV use and LVEF. Due to the
cross-sectional nature of our study no definite answer on the direction of these relationship
can be drawn and further longitudinal study on UA changes over time during an ACS
hospitalization are needed.
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Article info
Publication history
Published online: January 17, 2022
Accepted:
January 5,
2022
Received in revised form:
December 21,
2021
Received:
October 3,
2021
Identification
Copyright
© 2022 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
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- Uric acid and cardiovascular risk stratification in the acute coronary syndromes: a friend we should mindEuropean Journal of Internal MedicineVol. 99
- PreviewUric acid (UA) is the end product of purine metabolism. Whilst being primarily known as the leading risk factor for the onset of gout [1], UA has also been acknowledged as a significant CV risk factor [2]. However, international guidelines report as pathological threshold only the saturation point of UA (6.0 mg/dL in women and ≥7.0 mg/dL in men) [3], yet failing to identify a specific CV prevention cut-off [4]. This somewhat neglects UA predictive role in CV disease [5]. In a large (n=22,714) Italian-population based observation cohort study, we have described how UA markedly impact all-cause and CV mortality starting from lower serum levels (respectively, 4.7 and 5.6 mg/dL) [2].
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