Hyperuricemia Predicts Adverse Outcomes After Myocardial Infarction With Non-obstructive Coronary Arteries

Abstract

Background: Serum uric acid (SUA) is a well-known predictor of adverse outcomes in patients with various clinical conditions. However, the impact of SUA on patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) remains unclear. Here, we aimed at investigating the potential association between hyperuricemia and the adverse outcomes in MINOCA patients.Methods: Overall, 249 MINOCA patients were enrolled in the present study. Clinical characteristics and laboratory data, were measured in all patients. Based on SUA levels, patients were classified into two groups; the hyperuricemia group [SUA level > 6 mg/dL (360 μmol/L) in women and > 7 mg/dL (420 μmol/L) in men], and the normuricemia group. The primary endpoint of our study was major adverse cardiac events (MACE), defined as cardiovascular death, stroke, heart failure, non-fatal MI, and angina rehospitalization.Results: Seventy-two patients were in hyperuricemia group and 177 in normuricemia group. Fifty-two MACE events were recorded after 30 months of follow-up period. The incidence of MACE was higher in hyperuricemia group compared with normuricemia group (31.9 vs. 16.3%, P = 0.006). Kaplan-Meier survival curves illustrated a significantly increased risk of MACE in hyperuricemia group (log-rank P = 0.006). The multivariable logistic analysis demonstrated that hyperuricemia was independently associated with a high risk of MACE after 30 months of follow-up (OR, 2.234; 95% CI, 1.054–4.737, P = 0.036).Conclusion: Hyperuricemia is associated with adverse outcomes and appears to be an independent predictor of MACE in MINOCA patients. This finding suggests that the SUA levels may serve as a surrogate biomarker related to risk prediction and adverse outcomes of MINOCA patients.

Reduced stress perfusion in myocardial infarction with nonobstructive coronary arteries

“…However, further examinations of pathologies not detectable on traditional CMR is warranted. The role of CMD in MINOCA is increasingly recognized but cannot be diagnosed using traditional CMR 18 . Indeed, the workup of CMD is complex due to the many pathophysiological forms of CMD that patients present with and includes various modalities 18 .…”

“…Quantitative stress perfusion mapping can detect CMD as reduced global stress perfusion and/or myocardial perfusion reserve (MPR) 16 and can differentiate CMD from obstructive coronary artery disease (CAD) 17 . CMD has been shown in acute MINOCA and is associated with poor outcome both in the acute stage and long-term 18 . However, long-term presence of CMD following acute MINOCA presentation has to the best of our knowledge not been examined previously.…”

High Uric Acid Levels in Acute Myocardial Infarction Provide Better Long-Term Prognosis Predictive Power When Combined with Traditional Risk Factors

“…To date, limited studies with small populations have been conducted, and the results were not concordant in different subjects. Some studies have reported a correlation between UA and AMI [ 12 , 13 , 35 , 36 , 37 ]. However, it is still debatable whether hyperuricemia is an independent predictor of patients with percutaneous coronary intervention in the AMI cohort [ 15 ].…”

Hyperuricemia as a prognostic marker for long-term outcomes in patients with myocardial infarction with nonobstructive coronary arteries

“…To our knowledge, data regarding the implications of HUA in MINOCA population are scarce. A recent study enrolled 249 patients with MINOCA and reported that HUA was associated with adverse outcomes [ 37 ]. Here, we addressed this issue and conducted a larger scale and longitudinal analysis of MINOCA cohort.…”