P6395Elevated serum uric acid is associated with a greater inflammatory response and with short- and long-term mortality in patients with ST-segment elevation myocardial infarction undergoing primary percu
Authors: Mandurino Mirizzi A , Cornara S , Somaschini A , Demarchi A , Galazzi M , Puccio S , Crimi G , Ferlini M , Camporotondo R , Gnecchi M , Ferrario M , De Servi S , Oltrona Visconti L , De Ferrari G M 
Published: October 2019

Abstract

Introduction
Elevated serum uric acid (eSUA) has been identified as independent risk factors for cardiovascular diseases, including coronary artery disease, and it has been associated with increased mortality in the general population. However, whether eSUA is associated with adverse outcomes in the setting of ST-segment elevation myocardial infarction (STEMI) is still controversial. Although the mechanisms of this possible relationship is similarly unsettled it has been suggested that eSUA could trigger oxidative stress and inflammatory response.

Aim
This study sought to investigate the association between eSUA with short- and long-term mortality and with inflammatory response in patients with STEMI treated with primary percutaneous coronary intervention (pPCI).

Methods
We prospectively enrolled all STEMI patients undergoing pPCI in our hospital between 2005 and 2017. Blood samples were collected on admission and at 24 and 48 hours after pPCI: SUA and the inflammatory biomarkers C-reactive protein (CRP), neutrophil count and neutrophil to lymphocytes ratio (NLR) were parameter of interest. NLR was obtained by dividing the total count of neutrophil by the total count of lymphocyte. eSUA was defined as >6.8 mg/dl. Cumulative 30-days and 1-year mortalities were estimated using the Kaplan-Meyer analysis and compared with the long-rank test. Landmark analysis was set at 365 days. Multivariable analyses were performed by Cox proportional hazard models.

Results
Out of the dataset of 2959 STEMI patients treated with pPCI, we analyzed 2369 patients who had SUA data. Overall age was 63 (p25-p75: 54–73) years, men were 2295 (75.5%), anterior MI 1390 (45.8%). eSUA was present in 563 patients (23.8%). 30-day mortality was 5.8% (n=31) among patients with eSUA and 2% (n=34) among patient with normal SUA level (p<0.001); 1-year mortality was 8.5% (n=46) vs 4% (n=70), respectively (p<0.001). Landmark analysis is shown in Figure 1. At multivariable analyses eSUA was an independent predictor after adjusting for age, female gender, BMI, diabetes, previous MI, serum creatinine, Hb, acute glycemia, Killip class >2 (30-day mortality HR 1.196, 95% CI 1.006–1.321, p=0.042; 1-year mortality HR 1.178, 95% CI 1.052–1.320, p=0.005). On admission CRP was higher in the group with eSUA as compared with the group with normal SUA levels (respectively, 1.27 [0.57–3.37] mg/dl vs 0.72 [0.30–1.8] mg/dl, p<0.001). On admission neutrophil count and NLR did not differ among the groups (respectively, p=0.205 and p=0.399), but eSUA patients presented higher values in neutrophil count and NLR at 24 hours (respectively, p=0.020 and p<0.001) and at 48 hours (p=0.018 and both p<0.001).
Figure 1

Conclusions
Elevated serum uric acid is associated with higher short- and long-term mortality and with a greater inflammatory response after reperfusion in patients with STEMI treated with primary PCI.