Uric acid in-hospital changes predict mortality in patients with acute myocardial infarction

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Purpose: A high admission serum uric acid (UA) level is a predictor of adverse short and long-term outcome after acute myocardial infarction (AMI). We assessed the predictive role of admission, peak UA and their absolute difference during hospitalization in patients with AMI. Methods: We studied 375 consecutive patients admitted with the diagnosis of AMI (either ST or non-ST segment elevation) within 12 hours of symptoms' onset. From blood sample obtained on admission hemoglobin, white blood count, B-type natriuretic peptide (BNP), high sensitivity C-reactive protein, troponin I, plasma glucose, UA and creatinine were measured. UA levels were daily measured throughout hospitalization and their peak values were recorded in each patient. All patients underwent coronary arteriography and disease extension, left anterior descending (LAD) artery involvement, and subsequent revascularization status (complete or not) were recorded. Ejection fraction (EF) was estimated on admission with 2D echo. Primary end-points were 30-day and 1-year mortality. Results: Mortality rate at 30 days was 7.2% and at 1 year was 10.9%. Patients who died within 30 days exhibited higher peak UA (10.24 mg/dl vs. 7.06 mg/dl, p<0.001) and absolute UA elevation (1.7 mg/dl vs. 0.7 mg/dl, p<0.001). Optimal values for predicting 30-day mortality was 9.65 mg/dl for peak UA and 2.35 mg/dl for UA elevation. Mortality rate in patients with peak UA ≥9.65 mg/dl and UA elevation ≥2.35mg/dl compared to those with lower values was 31.4% vs. 3.4%, and 20.3% vs. 4.5%, respectively (both log-rank p<0.001). Regarding 1-year mortality prediction, 9.55 mg/dl for peak UA and 1.1 mg/dl for UA elevation emerged as optimal values. Incidence of 1-year mortality was higher in AMI patients with peak UA ≥9.55 mg/dl and UA elevation ≥1.1mg/dl (37.5% vs. 6.3%, log-rank p<0.001, and 18.2% vs. 6.7%, log-rank p=0.001, respectively). By applying multivariate Cox regression analysis, independent predictors of 30-day mortality were EF (HR 0.937, p=0.008), BNP (HR=3.497, p=0.006) and peak instead of admission UA, as examined in separate models (HR 1.157, p=0.030). Regarding 1 year mortality, EF (HR 0.965, p=0.043), BNP (HR=3.228, p<0.001), peak instead of admission UA (HR 1.204, p=0.001) and absolute difference in UA (HR 1.213, p=0.001), remained as the only independent predictors. Conclusions: Peak UA along with UA elevation, instead of admission UA emerged as independent predictors of 30-day and 1-year mortality. Serial UA measurements during hospitalization add significant prognostic information in AMI patients.

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