Serumska koncentracija mokraćne kiseline i ishod akutnog koronarnog sindroma

Car, Siniša (2012) Serumska koncentracija mokraćne kiseline i ishod akutnog koronarnog sindroma. PhD thesis, Sveučilište u Zagrebu.

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Abstract

Objectives. To assess predictivity of serum uric acid (SUA) levels determined on admission for 30-day outcomes (mortality and incidence of major adverse cardiac events [MACE]) and long-term outcomes (all-cause mortality) in acute myocardial infarction (AMI) patients. ----- Patients and Methods. This retrospective prognostic study included consecutive patients with verified AMI (with/without ST elevation; STEMI/NSTEMI) admitted to the Varaždin County General Hospital within 48 hours since the symptom onset, between January 1 1996 and December 31 2001. ----- Results. A total of 613 patients (age 27-90 years, 64.6% men, 77.3% STEMI, SUA 63-993 µmol/l) were included. Higher SUA, and particularly, hyperuricemia (SUA >420 in men >360 µmol/L in women) was independently associated with higher 30-day mortality (RR=1.87, 95% CI 1.25-2.81) and incidence of MACE (RR= 1.79, 1.26-2.55). Subgroup analysis confirmed this relationship in STEMI, NSTEMI, men and women. Hyperuricemia was also independently associated with higher 30-day mortality in patients with moderately to severely reduced glomerular filtration rate (eGFR <60 mL/min/1.73 m2) (n=309, RR=2.24, 1.40-3.59, p<0.001), but not in those with normal to mildly reduced eGFR (>or=60 mL/min/1.73 m to 2) (n=304, RR=1.13, 0.26-4.87, p=867). The same was observed regarding the incidence of MACE. Based on a 13-year observational period, higher SUA was associated with higher long-term all-cause mortality after AMI (HR by 100 µmol/L SUA= 2.99, 1.49-6.57; HR for hyperuricemia=32.9, 5.03-216). ----- Conclusion. Higher SUA on admission (and particularly, hyperuricemia) is a strong independent predictor of poor 30-day outcomes in unselected patients with AMI, in patients with STEMI, patients with NSTEMI, men or women. This association is conditional on renal function: it holds in patients with moderately to severely reduced eGFR but seemingly not in patients with normal to mildly reduced eGFR. Also, higher on-admission SUA is a strong independent predictor of poor long-term survival after AMI. On-admission SUA should be considered as an important factor in risk stratification in AMI patients.

Abstract in Croatian

Cilj. Ispitati prediktivnost razine serumske mokraćne kiseline (SMK) izmjerene na prijemu na 30-dnevne ishode (mortalitet i incidenciju velikih kardijalnih događaja (MACE) i dugoročno preživljenje (smrtnost svih uzroka) kod bolesnika sa akutnim infarktom miokarda (AIM). ----- Ispitanici i metode. Ova retrospektivna prognostička studija uključila je uzastopne bolesnike s dijagnosticiranim AIM (sa ili bez ST elevacije; STEMI/NSTEMI) zaprimljene u Opću bolnicu Varaždin unutar 48 sati od početka simptoma između 01.01.1996. i 31.12.2001. godine. ----- Rezultati. Uključeno je 613 bolesnika (dobi 27-90 godina, 64,6% muškaraca, 77,3% STEMI, SMK 63-993 µmol/l). Viša SMK, a posebno hiperuricemija (SMK>420 kod muškaraca i >360 µmol/L kod žena) neovisno je bila povezana sa višim 30-dnevnim mortalitetom (RR=1.87, 95% CI 1.25-2.81) i incidencijom MACE (RR= 1.79, 1.26-2.55). Analiza podgrupa pokazala je tu povezanost kod STEMI, NSTEMI, muškaraca i žena. Hiperuricemija je također neovisno povezana sa višom 30-dnevnom smrtnosti kod bolesnika sa srednje teško do teško sniženom glomerularnom filtracijom (eGFR <60 mL/min/1.73 m2) (n=309, RR=2.24, 1.40-3.59, p<0.001), ali ne i kod onih sa urednom do blago sniženom eGFR (>ili=60 mL/min/1.73 m na 2) (n=304, RR=1.13, 0.26-4.87, p=867). Isto opažanje vrijedi i za MACE. Temeljeno na praćenju kroz 13 godina, viša SMK je povezana sa višom dugoročnom smrtnosti bilo kojeg uzroka nakon AIM (HR za 100 µmol/L SMK= 2.99, 1.49-6.57; HR za hiperuricemiju=32.9, 5.03-216). ----- Zaključak. Viša izmjerena SMK na prijemu (a posebno hiperuricemija) je snažan neovisni prediktor lošijeg 30-dnevnog ishoda u neselektiranih bolesnika sa AIM, kod bolesnika sa STEMI, bolesnika sa NSTEMI, muškaraca i žena. Ta veza je uvjetovana sa bubrežnom funkcijom: javlja se kod bolesnika sa srednje teško do teško sniženom eGFR ali ne i kod onih sa normalno do blago sniženom eGFR. SMK izmjerena na prijemu je također i snažan neovisni prediktor lošijeg dugoročnog preživljenja nakon AIM. SMK izmjerena na prijemu trebala bi postati važni faktor stratifikacije rizika kod bolesnika sa AIM.

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