To Explore The Risk Factors Of Ticagrelor-induced New-onset Gout In Patients With ACS And To Establish A Risk Nomogram Model

Objective The clinical data of acute coronary syndrome(ACS)patients treated with ticagrelor in the Department of Cardiology of the First Affiliated Hospital of Dali University were retrospectively analyzed,and the prediction model of new gout attack in ACS patients treated with ticagrelor during hospitalization was established.To provide clinical decision making for the selection of oral antiplatelet agents in patients with ACS.Methods The data of ACS patients hospitalized in the Department of Cardiology of the First Affiliated Hospital of Dali University from January 2020 to February 2023 were retrospectively collected.A total of 1164 patients were divided into two groups according to different dual antiplatelet regimens.The first group was treated with aspirin + ticagrelor,with a total of 640 cases;The general information and laboratory data of the two groups were compared,and the changes of serum uric acid levels and the incidence of new gout in the two groups during hospitalization were statistically analyzed.Secondly,the ticagrelor group was divided into the gout group(n=63)and the non-gout group(n=577).The general data and laboratory data were compared between the two groups.The observation indicators with statistical significance were analyzed by univariate binary Logistic regression analysis,and the multivariate binary Logistic regression analysis was used to screen the independent risk factors of in-hospital new-onset gout,and a prediction model was established.ROC curve,area under the curve(AUC),Hosmer-lemoshow goodness of fit test and calibration curve were used to evaluate the discrimination and calibration of the model,respectively.Results1.A total of 1164 patients were enrolled,640 in the ticagrelor group and 524 in the clopidogrel group.The total incidence of in-hospital new-onset gout was 6.27%,including 63 cases(9.8%)in the ticagrelor group and 10 cases(1.9%)in the clopidogrel group.2.The baseline Serum uric acid(SUA)in the ticagrelor group was significantly different from that at discharge(P < 0.05),but there was no significant difference in the clopidogrel group(P > 0.05).The SUA at discharge was higher in the ticagrelor group(362.28±91.76umol/L)than in the clopidogrel group(349.02±67.25umol/L).3.Compared with the non-gout group with oral ticagrelor,In the gout group,there were significant differences in drinking history,Body mass index(BMI),baseline SUA,discharge SUA,Serum creatinine(Scr),white blood cell count(WBC),and Total cholesterol(TC),Triglycerides(TG),D-dimer(D-D)were statistically significant(P < 0.05).4.Multivariate analysis showed that drinking history,TC and baseline SUA were independent risk factors for gout attack induced by ticagrelor.Conclusions1.Ticagrelor is associated with a higher incidence of new-onset gout than clopidogrel in ACS patients.2.Drinking history,TC and baseline SUA are independent risk factors for gout attack induced by ticagrelor.3.This study successfully established a prediction model.The establishment of the prediction model and the nomogram can intuitively predict the risk and diagnostic efficiency of new-onset gout in hospital,which has a key guiding significance for clinical related prevention and treatment measures.