On-admission serum uric acid predicts outcomes after acute myocardial infarction: systematic review and meta-analysis of prognostic studies

Trkulja, Vladimir and Car, Siniša (2012) On-admission serum uric acid predicts outcomes after acute myocardial infarction: systematic review and meta-analysis of prognostic studies. Croatian Medical Journal, 53 (2). pp. 162-172. ISSN 0353-9504

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Abstract

AIM: To evaluate the prognostic value of serum uric acid (SUA) in acute myocardial infarction (AMI) patients. ----- METHODS: Systematic review and random-effects meta-analysis of prognostic studies assessing AMI outcomes (death, major adverse cardiac events, MACE) in relation to on-admission SUA. ----- RESULTS: Nine studies (7655 patients) were identified, 6 in the ST-segment elevation AMI patients treated with invasive revascularization and three in mixed AMI type cohorts with variable reperfusion strategies. "High" SUA (vs "low," different cut-offs) was univariately associated with higher short-term mortality (8 studies/6805 patients; odds ratio [OR], 3.24; 95% confidence interval [CI], 2.47-4.27) and incidence of MACE (7/6467; OR, 2.46; 95% CI, 1.84-3.27, moderate heterogeneity, mild bias), and with higher medium-term mortality (5/5194; OR, 2.69; 95% CI, 2.00-3.62, moderate heterogeneity, mild bias) and MACE (4/4299; OR, 1.93; 95% CI, 1.36-2.74, high heterogeneity, mild bias). It was independently associated with a higher short-term (4/3625; OR, 2.26, 95% CI, 1.85-2.77) and medium/long-term (3/2683; hazard ratio [HR], 1.30; 95% CI 1.01-1.68, moderate heterogeneity, mild bias) occurrence of poor outcomes (death/MACE). As a continuous variable (by 50 μmol/L), higher SUA was also independently associated with poorer medium/long-term outcomes (4/3533; HR, 1.19; 95% CI, 1.03-1.37, high heterogeneity, mild bias). All individual study effects (unadjusted or adjusted) were in the same direction, but differed in size. Heterogeneity was mainly due to the included AMI type and/or definition of MACE. All bias-corrected pooled effects remained significant. ----- CONCLUSION: Based on the available data, high(er) on-admission SUA independently predicts worse short-term and medium/long-term outcomes after AMI. However, the number of data are modest and additional prospective studies are warranted.

Abstract in Croatian

Urična kiselina u serumu kod primitka u bolnicu predviđa ishod nakon akutnog infarkta miokarda: sistemski pregledni rad i meta-analiza prognostičkih istraživanja ----- Cilj Odrediti prognostičku vrijednost urične kiseline u serumu (engl., SUA) kod pacijenata s akutnim infarktom miokarda. ----- Postupci Napravili smo sistemski pregledni rad i meta-analizu slučajnih učinaka prognostičkih istraživanja ishoda akutnog infarkta miokarda (smrt, veći neželjeni kardijalni događaji, engl., MACE) u odnosu na SUA-u na primitku u bolnicu. ----- Rezultati Identificirali smo 9 istraživanja (7655 pacijenata), 6 koja su uključila AMI pacijente s elevacijom ST-segmenta liječene invazivnom revaskularizacijom i 3 koja su uključila kohorte mješovitih AMI tipova s varijabilnim strategijama reperfuzije. “Visoka” SUA (nasuprot „niskoj,” različite granične vrijednosti) bila je univarijatno povezana s višim kratkoročnim mortalitetom (8 istraživanja/6805 pacijenata; omjer izgleda [engl, OR], 3,24; 95% raspon pouzdanosti [engl., CI], 2,47-4,27) i incidencijom MACE-a (7/6467; OR, 2,46; 95% CI, 1,84-3,27, umjerena heterogenost, blago iskrivljenje), i s višim srednjeročnim mortalitetom (5/5194; OR, 2,69; 95% CI, 2,00-3,62, umjerena heterogenost, blago iskrivljenje) i MACE-om (4/4299; OR, 1,93; 95% CI, 1,36-2.74, visoka heterogenost, blago iskrivljenje). Kao kontinuirana varijabla (do 50 mol/L), ona je bila i neovisno povezana s višom kratkoročnom (4/3625; OR, 2,26, 95% CI, 1,85-2,77) i srednje/dugoročnom (3/2683; omjer hazarda [HR], 1.30; 95% CI 1,01-1,68, umjerena heterogenost, blago iskrivljenje) pojavom neželjenih ishoda (smrt/MACE). Svi individualni učinci istraživanja (neprilagođeni ili prilagođeni) kretali su se u istom smjeru, ali su se razlikovali po veličini. Heterogenost je uglavnom bila uzrokovana uključenim AMI tipovima i/ili definicijom MACE-a. Svi združeni učinci ispravljeni zbog iskrivljenja ostali su značajni. ----- Zaključak Dostupni podaci pokazuju da viša SUA na primitku u bolnicu neovisno predviđa nepovoljnije kratkoročne i srednje/dugoročne ishode nakon AMI-ja. Ipak, broj podatka je malen i potrebna su daljnja prospektivna istraživanja.

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