Elevated serum uric acid is associated with a greater inflammatory response and with short- and long-term mortality in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

Mandurino-Mirizzi, Alessandro; Cornara, Stefano; Somaschini, Alberto; Demarchi, Andrea; Galazzi, M; Puccio, S; Montalto, Claudio; Ferlini, Marco; Camporotondo, Rita; Gnecchi, Massimiliano; Ferrario, Maurizio; Oltrona-Visconti, L; Ferrari, Gaetano Maria De

doi:10.1016/j.numecd.2020.10.020

Cited by 28 publications

(22 citation statements)

References 30 publications

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“…Hyperuricemia indicates an increased risk of diabetes mellitus or metabolic syndrome and it may lead to hypertension and cardiovascular disease [19,20], therefore it is essential to provide these patients with adequate care. Elevated serum uric acid has been associated not only with several cardiovascular risk factors but also with an increased cardiovascular mortality in the general population [21,22] and after acute myocardial infarction [23,24]. Moreover, in the setting of acute myocardial infarction, hyperuricemia has been linked with an increased inflammatory response [25].…”

Section: Discussionmentioning

confidence: 99%

How Are We Managing Patients with Hyperuricemia and Gout: A Cross Sectional Study Assessing Knowledge and Attitudes of Primary Care Physicians?

Furlan

Rušić

Božić

et al. 2021

IJERPH

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Background: Studies show that hyperuricemia is an element of the pathophysiology of many conditions. Therefore, the aim of this study was to assess primary care physicians’ knowledge and attitudes toward asymptomatic hyperuricemia and gout management. Methods: A survey-based cross-sectional study was conducted to assess the primary physicians’ attitudes, knowledge, and patient management regarding hyperuricemia and gout. Results: A total of 336 primary care physicians were included. Physicians who read at least one scientific paper covering the topic of hyperuricemia in the past year scored significantly higher in knowledge questions (N = 152, 6.5 ± 2.05 vs. N = 183, 7.04 ± 2.14, p = 0.019). Only around half of physicians correctly identified drugs that can lower or elevate serum uric acid levels. Furthermore, the analysis of correct answers to specific questions showed poor understanding of the pathophysiology of hyperuricemia and possible risk factors. Conclusions: This study identified gaps in primary care physicians’ knowledge essential for the adequate management of patients with asymptomatic hyperuricemia and gout. As hyperuricemia and gout are among the fastest rising non-communicable diseases, greater awareness of the available guidelines and more education about the causes and risks of hyperuricemia among primary care physicians may reduce the development of diseases that have hyperuricemia as risk factors.

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Section: Discussionmentioning

confidence: 99%

How Are We Managing Patients with Hyperuricemia and Gout: A Cross Sectional Study Assessing Knowledge and Attitudes of Primary Care Physicians?

Furlan

Rušić

Božić

et al. 2021

IJERPH

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“…Studies on patients treated with allopurinol for gout and hyperuricemia showed inconsistent results regarding changes in all-cause and CVD-related mortality [ 20 ]. The link between SUA and CVD-related mortality in patients with acute myocardial infarction (MI) was reported in several studies [ 21 , 22 , 23 ]. A significantly elevated mortality risk has already been found in patients with SUA levels > 6.8 mg/dL [ 22 , 23 ].…”

Section: Introductionmentioning

confidence: 99%

“…The link between SUA and CVD-related mortality in patients with acute myocardial infarction (MI) was reported in several studies [ 21 , 22 , 23 ]. A significantly elevated mortality risk has already been found in patients with SUA levels > 6.8 mg/dL [ 22 , 23 ]. However, studies evaluating the effect of SUA on mortality at levels above its upper limit of normal do not determine the exact concentration above which this effect is significant.…”

Section: Introductionmentioning

confidence: 99%

Serum Uric Acid Is a Weak Independent Predictor of Overall Survival in Older Adults

Winder

Owczarek

Mossakowska

et al. 2021

JCM

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Hyperuricemia accompanies many pathologies that contribute to overall death rate. The population-based multifaceted study of older adults in Poland made it possible to assess the effect of serum uric acid (SUA) on overall mortality. The PolSenior study performed between 2007–2011 included 3926 participants aged 65 years or above (mean age 79 ± 9 years) not treated with xanthin oxidase inhibitors (XOI) who were stratified by sex and SUA concentration into six subgroups increasing by 1 mg/dL. In 2019, survival data were retrieved from the population register. The crude risk of death was significantly higher in men and women with SUA ≥ 7 mg/dL. After adjustment to statistically significant factors, SUA remained a risk factor of death in men with SUA ≥ 8 mg/dL only, potentially due to the limited number of women with high SUA levels. Furthermore, age, heart failure, diabetes, and activities of daily living ≤ 4 pts were identified as factors increasing mortality risk regardless of sex. The risk of death increased also with smoking, past stroke, COPD/asthma, and hs-CRP > 3 mg/dL for men; and eGFR < 45 mL/min/1.73 m2, mini nutritional assessment ≤ 7 pts, and loop diuretics use for women. Mild hyperuricemia is a significant health status marker and an independent risk factor for overall mortality in older Caucasians not receiving XOI. Increased mortality is mostly limited to subjects with SUA levels ≥ 8 mg/dL.

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“…In addition, the hyperuricaemic group had more multi-vessel coronary artery disease than non-hyperuricaemic group, which was consistent with previous studies. 8,11 Akpek showed that an elevated SUA level on admission was a strong predictor of poor coronary blood flow in patients with STEMI undergoing pPCI, which was probably influenced by an increased inflammatory response. 11 However, the author reported that the incidence of no-reflow was as high as 43%, which may have combined with the impact of limited drug use and the intervention procedure at that time.…”

Section: Discussionmentioning

confidence: 99%

“…7 As the final product of purine metabolism in the circulation, serum uric acid (SUA) is related to the degree of inflammation and mortality in STEMI. 8 During the SUA production process, oxygen free radicals are generated and evoked an inflammatory reaction, increasing atherosclerotic plaque activity over time. 9 When STEMI occurs, plaque rupture triggers local inflammatory response and eventually leads to NRP.…”

Section: Introductionmentioning

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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Elevated serum uric acid is associated with a greater inflammatory response and with short- and long-term mortality in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

Cited by 28 publications

References 30 publications

How Are We Managing Patients with Hyperuricemia and Gout: A Cross Sectional Study Assessing Knowledge and Attitudes of Primary Care Physicians?

How Are We Managing Patients with Hyperuricemia and Gout: A Cross Sectional Study Assessing Knowledge and Attitudes of Primary Care Physicians?

Serum Uric Acid Is a Weak Independent Predictor of Overall Survival in Older Adults

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

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