| Study background：An elevated serum uric acid level has been associated withcardiovascular disease in epidemiologic studies, and it is an independent predictivefactor in healthy people and CHD people. Studies reported that high SUA level isassociated with impaired myocardial flow. But little is known regarding the predictivevalue of uric acid for impaired coronary flow and the relation between uric acid andshort-term、long-term outcomes in STEMI patients undergoing primary percutaneouscoronary intervention(PCI).Study objective：To study the effects of admission SUA level on coronary bloodflow and short-term、long-term prognosis in STEMI patients undergoing primary PCI.Study methods： All patients that were consecutively admitted， with thediagnosis of STEMI within12hours from the onset of symptoms were enrolled thestudy. All of the patients were treated with primary PCI at Hai Dian hospital fromJanuary2010to June2013. Patients were divided into two groups based on theadmission uric acid level: elevated uric acid group(>420umol/l in men,>360umol/l inwomen),24male(77.4%),7female(22.6%)；normal SUA group(≤420umol/l in men，≤360umol/l in women),82male(75.9%),76female(24.1%).All patients were furthertreated in cardiac care unit(CCU) after primary PCI. We collected the clinical data、laboratory test data、transthoracic echocardiography、coronary angiography resultsand recorded the in-hospital mortality and major adverse cardiac events(MACEs) ofall STEMI patients after primary PCI in CCU. We also evaluated six-month mortalityand MACEs after PCI during long-term clinical follow-up. Multivariate analyseswere used to examine the association of uric acid with coronary flow and mortalityand MACEs of in-hospital and six-month in ST-Segment elevation myocardialinfarction patients undergoing primary PCI.Study results：139STEMI patients undergoing primary PCI were enrolled thestudy,106male(76.3%),33female(23.7%).There were31patients(22.3%) in theelevated uric acid group and108patients(77.7％)in the normal uric acid group.Patients with elevated uric acid group had a significant higher prevalence ofhypertension(54.8％vs32.4％，P<0.05)，previous myocardial infarction(19.4％vs8.3 ％，P<0.05)、multivessel diseas（e61.3％vs37.0％，P<0.05) compared with the normaluric acid group. There were no significant differences between the two groups interms of Killip classesⅠ(54.8％vs73.1％，P=0.06)、Killip classesⅡ(12.9％vs18.5％，P=0.47) on admission, while Killip classes Ⅲ(16.1％vs3.7％，P<0.05) and Killipclasses Ⅳ(16.1％vs4.6％，P<0.05) were more frequent in the elevated uric acid group.With respect to transthoracic echocardiography, the left ventricular ejection fractionon admission was lower in the high uric acid group than the normal uric acid group(49±15％vs54±11％，P<0.05). There were significant differences between the twogroup in terms of no-reflow(TIMI grade0、1、2flow) on angiography(29.0％vs10.2％，P<0.05). Patients with elevated uric acid group had significant higher in-hospitalprevalence of MACEs（25.8％vs7.4％，P<0.05).Six-month prevalence of MACEswas higher in patients with elevated uric acid group(25.2％vs23.1％，P<0.05).In amultivariate analyses, when adjusted for mixed factors, uric acid on admission is anindependent risk factor of impaired coronary blood flow following primary PCI andin-hospital MACEs among patients with STEMI(OR=1.0995%CI1.02-1.18,P<0.05；OR=1.0995%CI1.02-1.12, P<0.05, respectively).Study conclusions：Uric acid on admission is independently associated withimpaired coronary blood flow following primary PCI. In addition, uric acid is anindependent risk factor of in-hospital MACEs among patients with STEMIundergoing primary PCI.As a simple, quick, cheap, available assessed biomarker, uricacid not only is strongly predictive for impaired coronary flow following primary PCI,but also is a useful biomarker for stratification of risk in patients with STEMI. |
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