Elevated serum uric acid affects myocardial reperfusion and infarct size in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

Mandurino-Mirizzi, Alessandro; Raineri, Claudia; Pica, Silvia; Ruffinazzi, Marta; Gianni, Umberto; Repetto, Alessandra; Ferlini, Marco; Marinoni, Barbara; Leonardi, Sergio; Servi, Stefano De; Visconti, Luigi Oltrona; Ferrari, Gaetano M. De; Ferrario, Maurizio

doi:10.2459/jcm.0000000000000634

Cited by 25 publications

(14 citation statements)

References 27 publications

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“…Thus, finding from animal study cannot necessarily be generalized to species with comparatively low activities of XO. Meanwhile, hyperuricemia is associated with impaired myocardial reperfusion and greater infarct size [ 30 , 31 ], which associated with higher rates of ventricular arrhythmias [ 32 , 33 ]. The present study confirmed these data: patients with hyperuricemia presented with increased troponin I levels, risk of no-reflow and worse LVEF.…”

Section: Discussionmentioning

confidence: 99%

Hyperuricemia is associated with an increased prevalence of ventricular tachycardia and fibrillation in patients with ST-elevation myocardial infarction after primary percutaneous coronary intervention

Wang

2022

BMC Cardiovasc Disord

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Background Little is known about the association between hyperuricemia and ventricular tachycardia and fibrillation (VT/VF) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). Methods The data from a cohort of STEMI patients undergoing PPCI at our center from January 2013 to December 2018 were retrospectively analyzed. The endpoint of the study was the occurrence of VT/VF, including (1) non-sustained ventricular tachycardia (nsVT) on Holter monitoring; (2) sustained ventricular tachycardia (SVT)/VF on cardiac monitoring. Results Of the 634 patients included in the study, 147 (23.2%) of them had hyperuricemia. The occurrence of VT/VF after PPCI was significantly higher in patients with hyperuricemia (19.0 vs. 9.4%, p = 0.001) compared with those without hyperuricemia. Hyperuricemia was associated with a significantly higher risk of VF/VT (odds ratio (OR) 2.11; 95% CI 1.11–4.03; p = 0.024). The strength of this association remained statistically after adjustments for age, sex, history of hypertension, estimated glomerular filtration rate, hypersensitive C reactive protein, plasma natrium, peak troponin I, fasting glucose, B-type natriuretic peptides and VT/VF in PPCI (adjusted odds ratio 2.73; 95% CI 1.19–6.27; p = 0.018). Conclusions There is a significant association between hyperuricemia and increased prevalence of VT/VF in STEMI patients after PPCI, independently of multiple risk factors and potential confounders.

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Section: Discussionmentioning

confidence: 99%

Hyperuricemia is associated with an increased prevalence of ventricular tachycardia and fibrillation in patients with ST-elevation myocardial infarction after primary percutaneous coronary intervention

Wang

2022

BMC Cardiovasc Disord

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“…STEMI was diagnosed based on two of the three following criteria: (1) typical signs of ST‐segment elevation in two contiguous leads on electrocardiogram; (2) typical signs of elevated cardiac biomarkers, including troponin, creatine kinase and creatine kinase‐myocardial band (CK‐MB), which were increasing proportionally; and (3) typical chest pain symptoms. SUA was measured on admission with the same method, and patients were divided into two groups based on an SUA cut‐off level of 6.8 mg/dL, as previously reported 14,15 …”

Section: Methodsmentioning

confidence: 99%

Elevated uric acid is related to the no‐/slow‐reflow phenomenon in STEMI undergoing primary PCI

Yang

et al. 2021

Eur J Clin Investigation

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Background:No-/slow-reflow phenomenon (NRP) is a severe complication in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI). This study aimed to explore the relationship between elevated serum uric acid (SUA) and NRP in patients with STEMI undergoing pPCI, focusing on inflammation and angiographic findings.Methods: A total of 610 patients who received pPCI for STEMI were retrospectively enrolled. Patients were divided into a hyperuricaemia group and a non-hyperuricaemia group according to SUA levels. Clinical information and angiographic indicators were compared between the two groups. Thrombolysis in myocardial infarction (TIMI) flow and TIMI myocardial perfusion grade (TMPG) <3 after stent implantation were defined as TIMI-NRP and TMPG-NRP, respectively. A logistic model was used to analyse the relationship between hyperuricaemia and NRP. Results:The hyperuricaemia group had a higher incidence of TIMI-NRP (24.9% vs 14.0%, p < .001) and TMPG-NRP (33.0% vs 24.9%, p = .03), higher levels of C-reactive protein (7.2 vs 4.1 mg/L, p < .001) and worse left ventricular ejection fraction (51.5% vs 54.0%, p = .002) than the non-hyperuricaemia group. As for angiographic findings, there was no significant difference between the two groups in terms of lesion characteristics measured by quantitative coronary angiography. After multivariable adjustment, elevated SUA was significantly associated with TIMI-NRP (odds ratio: 1.94, 95% confidence interval: 1.24-3.01, p = .003). Subgroup analysis showed that the effect of hyperuricaemia in TIMI-NRP was more pronounced in patients with delayed perfusion as well as in patients with diabetes mellitus.Conclusions: Elevated SUA is associated with severe inflammation and has higher incidence of TIMI-NRP in patients with STEMI undergoing pPCI, especially in those with delayed perfusion or diabetes mellitus.

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“…Although an elevated SUA may induce larger acute infarct size, the study concluded that there is no further impairment in the repairing phase as infarct size shrinkage is similar compared with patients who have normal SUA levels. 58 Kojima et al 59 suggested that patients with hyperuricemia with an AMI have a higher rate of left ventricular systolic and diastolic dysfunction, as well as MACE (including heart failure, death), possibly because UA could increase oxidative stress and inflammation inducing cardiomyocyte apoptosis with further myocardial remodeling.…”

Section: Uric Acid and Acute Myocardial Infarctionmentioning

confidence: 99%

The Role of Uric Acid in the Acute Myocardial Infarction: A Narrative Review

et al. 2021

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Increased serum uric acid (SUA) levels have been associated with various pathologic processes such as increased oxidative stress, inflammation, and endothelial dysfunction. Thus, it is not surprising that increased SUA is associated with various adverse outcomes including cardiovascular (CV) diseases. Recent epidemiological evidence suggests that increased SUA may be related to acute myocardial infarction (AMI). Accumulating data also showed that elevated UA has pathophysiological role in the development of AMI. However, there are also studies showing that SUA is not related to the risk of AMI. In this narrative review, we summarized the recent literature data regarding SUA and AMI after providing some background information for the association between UA and coronary artery disease. Future studies will show whether decreasing SUA levels is beneficial for outcomes related to AMI and the optimum SUA levels for best outcomes in CV diseases.

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Elevated serum uric acid affects myocardial reperfusion and infarct size in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

Abstract: eSUA may affect myocardial reperfusion in patients with STEMI undergoing percutaneous coronary intervention and is associated with larger infarct size and higher long-term mortality.

Cited by 25 publications

References 27 publications

Hyperuricemia is associated with an increased prevalence of ventricular tachycardia and fibrillation in patients with ST-elevation myocardial infarction after primary percutaneous coronary intervention

Hyperuricemia is associated with an increased prevalence of ventricular tachycardia and fibrillation in patients with ST-elevation myocardial infarction after primary percutaneous coronary intervention

Elevated uric acid is related to the no‐/slow‐reflow phenomenon in STEMI undergoing primary PCI

The Role of Uric Acid in the Acute Myocardial Infarction: A Narrative Review

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