Hyperuricaemia: nationwide study in st-elevation myocardial infarction patients

Hyperuricemia has been found to be a poor prognostic factor in patients with cardiovascular disease.

To determine the prognostic value of hyperuricemia in patients with ST elevation myocardial infarction (STEMI).

All patients presenting with a STEMI to the local hospital (the single nationwide hospital) from 2013 to 2017 were included in this retrospective study. Patients were excluded if they did not have an available uric acid level taken during the index hospital admission or within 1 year of the admission, and/or if treated conservatively (no primary percutaneous coronary intervention [PCI]).

Patients were followed up until end August 2024. Patients were stratified into 2 groups according to uric acid levels; Group 1: Normal and Group 2: Elevated (above 416.5umol/L in males and above 339.2umol/L in females).

Prognosis was evaluated using major adverse cardiovascular events (MACE) including unstable angina, myocardial infarction (MI), hospitalisation due to pulmonary oedema and revascularization with repeat PCI or coronary artery bypass grafting and all-cause mortality.

Chi-square was used for statistical analysis of categorical data. Mann-Whitney U test was used for continuous data (non-normal distribution). Kaplan-Meier (KM) curves for time-to-first MACE and cumulative all-cause mortality were calculated. P value <0.05 was considered significant.

1080 patients presented with a STEMI between 2013 and 2017. 540 patients were excluded (no available uric acid) and a further 43 patients were excluded (treated conservatively). Baseline characteristics were collected as shown in Figure 1.

Group 2 patients had higher incidence of MACE and all-cause mortality (11.9% vs 17.6%, p<0.001). KM analysis for MACE revealed no significant difference between group 1 and 2, however, it revealed a trend towards significance with a higher cumulative incidence of MACE in group 2. KM curve for survival revealed a significantly increased cumulative incidence of all- cause mortality in group 2 compared to group 1 (p<0.001)/ KM curves are shown in Figure 2 and its corresponding legend.