Study of Serum Uric Acid Levels in Myocardial Infarction and Its Association With Killip Class
Abstract
The present study aimed to compare the serum level of uric acid in patients with and without heart failure and also to determine the association between uric acid level and clinical status by Killip class in patients with STEMI. This case-control study was conducted on 50 consecutives as control group and 50 patients with acute heart failure, (20 patients had acute STEMI), who documented by both clinical conditions and echocardiography assessment. The mean plasma level of uric acid in the case group was 7.6±1.6 milligrams/deciliter (mg/dL) and in the control group was 4.5±1.5 respectively (P<0.001). These values in patients with STEMI was about 9.2±0.86, but in patients with acute heart failure in absence of STEMI was 6.5±1.04 (P<0.001). Moreover, there was significant difference among the level of uric acid and Killip classes (P<0.001). Also there was significant difference for uric acid level between HFrEF (HF with reduced EF) and severe LV systolic dysfunction (0.049). In STEMI patients with culprit LAD, mean uric acid was significantly higher than cases with culprit LCX [(9.7±0.98 versus 8.6±0.52 respectively) P=0.012]. Regarding treatment plan in patients with STEMI, mean level of uric acid in those considered for CABG was significantly higher than who were considered for PCI, 9.9±0.82 versus 8.9±0.76 respectively, P=0.029. In STEMI patients with higher killip class, higher level of uric acid was seen. Also, the severity of LV systolic dysfunction was associated with higher level of uric acid.
Liu CW, Liao PC, Chen KC, Chiu YW, Liu YH, Ke SR, et al. Relationship of serum uric acid and Killip class on mortality after acute ST-segment elevation myocardial infarction and primary percutaneous coronary intervention. Int J Cardiol 2017;226:26-33.
Shani M, Vinker S, Dinour D, Leiba M, Twig G, Holtzman EJ, et al. High normal uric acid levels are associated with an increased risk of diabetes in lean, normoglycemic healthy women. J Clin Endocrinol Metab 2016;101:3772-8.
So A, Thorens B. Uric acid transport and disease. J ClinInvest 2010;120:1791-9.
Desideri G, Castaldo G, Lombardi A, Mussap M, Testa A, Pontremoli R et al. Is it time to revise the normal range of serum uric acid levels. Eur Rev Med Pharmacol Sci2014;18:1295-306.
Cai W, Duan XM, Liu Y, Yu J, Jiang S, Zhang CP, et al.Uric Acid Induces Endothelial Dysfunction by Activating the HMGB1/RAGE Signaling Pathway. Biomed Res Int 2017;2017:4391920.
Akpek M, Kaya MG, Uyarel H, Yarlioglues M, Kalay N, Gunebakmaz O, et al., The association of serum uric acid levels on coronary flow in patients with STEMI undergoing primary PCI. Atherosclerosis 2011;219:334-41.
Anker SD, Doehner W, Rauchhaus M, Sharma R, Francis D, Knosalla C, et al. Uric acid and survival in chronic heart failure. Circulation 2003;107:1991-7.
Cappola TP, Kass DA, Nelson GS, Berger RD, Rosas GO, Kobeissi ZA, et al. Allopurinol improves myocardial efficiency in patients with idiopathic dilated cardiomyopathy. Circulation 2001;104:2407-11.
Pérez NG, Gao WD, Marbán E. Novel myofilament Ca2+- sensitizing property of xanthine oxidase inhibitors. Circ Res 1998;83:423-30.
Waring SW, Webb DJ, Maxwell SR. Systemic uric acid administration increases serum antioxidant capacity in healthy volunteers. J Cardiovasc Pharmacol 2001;38:365-71.
Kang DH, Nakagawa T, Feng L, Watanabe S, Han L, Mazzali M, et al. A role for uric acid in the progression of renal disease. J Am Soc Nephrol 2002;13:2888-97.
Mazzali M, Hughes J, Kim YG, Jefferson JA, Kang DH, Gordon KL, et al., Elevated uric acid increases blood pressure in the rat by a novel crystal-independent mechanism. Hypertension 2001;38:1101-6.
Sánchez-Lozada LG, Tapia E, Avila-Casado C, Soto V, Franco M, Santamaría J, et al. Mild hyperuricemia induces glomerular hypertension in normal rats. Am J Physiol Renal Physiol 2002;283:F1105-10.
Waring W, Webb D, Maxwell S. Effect of local hyperuricaemia on endothelial function in the human forearm vascular bed. Br J Clin Pharmacol 2000;49:511P.
El-Menyar A, Zubaid M, AlMahmeed W, Sulaiman K, AlNabti A, Singh R, et al., Killip classification in patients with acute coronary syndrome: insight from a multicenter registry. Am J Emerg Med 2012;30:97-103.
DeGeare VS, Boura JA, Grines LL, O'Neill WW, Grines CL. Predictive value of the Killip classification in patients undergoing primary percutaneous coronary intervention for acute myocardial infarction. Am J Emerg Cardiol 2001;87:1035-8.
Kojima S, Sakamoto T, Ishihara M, Kimura K, Miyazaki S, Yamagishi M, et al. Prognostic usefulness of serum uric acid after acute myocardial infarction (the Japanese Acute Coronary Syndrome Study). Am J Emerg Cardiol 2005;96:489-95.
Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, et al. 2016 ESC Guidelines for the diagnosis and
treatment of acute and chronic heart failure. Kardiol Pol 2016;74:1037-147.
Niizeki T, Takeishi Y, Arimoto T, Okuyama H, Nozaki N, Hirono O, et al. Hyperuricemia associated with high cardiac event rates in the elderly with chronic heart failure. J Cardiol 2006;47:219-28.
Files | ||
Issue | Vol 55, No 2 (2017) | |
Section | Original Article(s) | |
Keywords | ||
Heart failure Uric acid Killip class Myocardial infarction |
Rights and permissions | |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |