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On-admission serum uric acid predicts outcomes after acute myocardial infarction: systematic review and metaanalysis of prognostic studies

Vladimir Trkulja ; Department of Pharmacology, University of Zagreb School of Medicine, Zagreb, Croatia
Siniša Car ; Cardiology unit, Department of Internal Medicine, General Hospital Varaždin, Varaždin, Croatia

Puni tekst: engleski pdf 1.083 Kb

str. 162-172

preuzimanja: 840



Aim To evaluate the prognostic value of serum uric acid
(SUA) in acute myocardial infarction (AMI) patients.
Methods Systematic review and random-effects metaanalysis
of prognostic studies assessing AMI outcomes
(death, major adverse cardiac events, MACE) in relation to
on-admission SUA.
Results Nine studies (7655 patients) were identified, 6 in
the ST-segment elevation AMI patients treated with invasive
revascularization and three in mixed AMI type cohorts
with variable reperfusion strategies. “High” SUA (vs “low,”
different cut-offs) was univariately associated with higher
short-term mortality (8 studies/6805 patients; odds ratio
[OR], 3.24; 95% confidence interval [CI], 2.47-4.27) and
incidence of MACE (7/6467; OR, 2.46; 95% CI, 1.84-3.27,
moderate heterogeneity, mild bias), and with higher medium-
term mortality (5/5194; OR, 2.69; 95% CI, 2.00-3.62,
moderate heterogeneity, mild bias) and MACE (4/4299;
OR, 1.93; 95% CI, 1.36-2.74, high heterogeneity, mild bias).
It was independently associated with a higher short-term
(4/3625; OR, 2.26, 95% CI, 1.85-2.77) and medium/longterm
(3/2683; hazard ratio [HR], 1.30; 95% CI 1.01-1.68,
moderate heterogeneity, mild bias) occurrence of poor
outcomes (death/MACE). As a continuous variable (by 50
μmol/L), higher SUA was also independently associated
with poorer medium/long-term outcomes (4/3533; HR,
1.19; 95% CI, 1.03-1.37, high heterogeneity, mild bias). All
individual study effects (unadjusted or adjusted) were in
the same direction, but differed in size. Heterogeneity was
mainly due to the included AMI type and/or definition of
MACE. All bias-corrected pooled effects remained significant.
Conclusion Based on the available data, high(er) on-admission
SUA independently predicts worse short-term
and medium/long-term outcomes after AMI. However, the
number of data are modest and additional prospective
studies are warranted

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