FREQUENCY OF HYPERURICEMIA IN SUBJECTS WITH UNSTABLE ANGINA/MYOCARDIAL INFARCTION AND THEIR PROGNOSIS

Authors

  • Amir Rashid Qureshi Abbottabad International Medical College
  • Syed Affan Ali Abbottabad International Medical College
  • Mir Jalal Women Medical College, DHQ Hospital, Abbottabad.
  • Syed Imran Ahmed Benazir Bhutto Shaheed Teaching Hospital, Abbottabad.
  • Atifa Gillani Abbottabad International Medical College
  • Wahaj Abbottabad International Medical College

DOI:

https://doi.org/10.55519/JAMC-03-9552

Keywords:

Acute coronary Syndrome, Hyperuricemia, Uric Acid, cardiogenic shock, mortality, ST elevation myocardial infarction (STEMI), non ST elevation acute coronary syndrome (NSTE-ACS)

Abstract

ABSTRACT                                                                                                                                                                           Background: Inhibition of nitric oxide synthesis and stimulation of smooth muscle proliferation by increased serum levels of uric acid play an important role in accelerated atherogenesis in the vessels of patients with hyperuricemia. The objective of the study was to determine the frequency of hyperuricemia in patients with acute coronary syndrome and their in-hospital outcomes. Methods: This cross-sectional study was conducted in the cardiology department of Ayub Teaching Hospital, Abbottabad from ­­­­­­­­­­­­­­­­­­­1st September, 2018 to 28th February, 2019. A total of 199 patients diagnosed with acute coronary syndrome (ACS) were enrolled in this study using non-probability consecutive sampling. Diagnosis of ACS was made on history, electrocardiogram (ECG) findings and on the presence of elevated cardiac biomarkers. Serum uric acid was checked within 24 hours of presentation and patients were grouped into hyperuricemic and normouricemic groups according to uric acid levels. Next in-hospital outcomes were compared between the two groups by comparing the presence or absence of complications. The data was collected on a structured proforma and was analyzed statistically by using SPSS version 16. Results: Out of 199 patients, 146 (73.37%) were male and 53 (26.63%) were female. The mean age of the study participants was 57.99 ± 6.07 years with a range of 48-68 years. Hyperuricemia was diagnosed in 50 (25.13%) study participants. Among complications, 15 patients (7.94%) had cardiogenic shock, 27 (13.57%) had heart failure, 10 (5.03%) had cardiac arrhythmias, 16 (8.04%) had conduction defects and hyperuricemia was diagnosed in 50 (25.13%) patients. Cardiogenic shock was more common in patients with hyperuricemia (p < 0.05). Conclusion: Hyperuricemia is associated with a number of significant adverse outcomes for patients with an acute coronary event. Regular screening / monitoring of serum uric acid level in general population can prevent the direct and indirect morbidity associated with hyperuricemia. Keywords: Acute coronary Syndrome, Hyperuricemia, Uric Acid, cardiogenic shock, mortality, ST elevation myocardial infarction (STEMI), non ST elevation acute coronary syndrome (NSTE-ACS)  

Author Biographies

Amir Rashid Qureshi, Abbottabad International Medical College

Senior Registrar, Cardiology

Syed Affan Ali, Abbottabad International Medical College

Assistant Professor, Medicine Department

Mir Jalal, Women Medical College, DHQ Hospital, Abbottabad.

Associate Professor, Department of medicine.

Syed Imran Ahmed, Benazir Bhutto Shaheed Teaching Hospital, Abbottabad.

Medical Officer, Cardiology

Atifa Gillani, Abbottabad International Medical College

Senior Registrar, Neurology.

Wahaj, Abbottabad International Medical College

Senior Registrar, Nephrology

References

Amsterdam EA, Wenger NK, Brindis RG, Casey DE, Ganiats TG, Holmes DR, et al. 2014 AHA/ACC guideline for the management of patients with non–ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014;64(24):e139–228.

Roffi M, Patrono C, Collet JP, Mueller C, Valgimigli M, Andreotti F, et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J 2016;37(3):267–315.

Rodriguez F, Mahaffey KW. Management of patients with NSTE-ACS: a comparison of the recent AHA/ACC and ESC Guidelines. J Am Coll Cardiol 2016;68(3):313–21.

IJkema B, Bonnier J, Schoors D, Schalij M, Swenne C. Role of the ECG in initial acute coronary syndrome triage: primary PCI regardless presence of ST elevation or of non-ST elevation. Neth Heart J 2014;22(11):484–90.

Shah AS, Anand A, Sandoval Y, Lee KK, Smith SW, Adamson PD, et al. High-sensitivity cardiac troponin I at presentation in patients with suspected acute coronary syndrome: a cohort study. Lancet 2015;386(10012):2481–8.

Hedayati T, Yadav N, Khanagavi J. Non–ST-Segment Acute Coronary Syndromes. Cardiol Clin 2018;36(1):37–52.

Santos-Gallego CG, Picatoste B, Badimón JJ. Pathophysiology of acute coronary syndrome. Curr Atheroscler Rep 2014;16(4):401.

Adam AM, Rehan A, Waseem N, Iqbal U, Saleem H, Ali MA, et al. Prevalence of Conventional Risk Factors and Evaluation of Baseline Indices Among Young and Elderly Patients with Coronary Artery Disease. J Clin Diagn Res 2017;11(7):OC34–9.

Zuo T, Liu X, Jiang L, Mao S, Yin X, Guo L. Hyperuricemia and coronary heart disease mortality: a meta-analysis of prospective cohort studies. BMC Cardiovasc Disord 2016;16(1):207.

Song P, Wang H, Xia W, Chang X, Wang M, An L. Prevalence and correlates of hyperuricemia in the middle-aged and older adults in China. Sci Rep 2018;8(1):4314.

Abdullah AS, Begum N, Khan MAH, Hossain M, Kabir SMEJ, Alam MS, et al. Admission Serum Uric Acid Levels and In-Hospital Outcomes in Patients with Acute Coronary Syndrome. J Enam Med Col 2015;5(1):15–22.

Ali N, Perveen R, Rahman S, Mahmood S, Rahman S, Islam S, et al. Prevalence of hyperuricemia and the relationship between serum uric acid and obesity: A study on Bangladeshi adults. PLoS One 2018;13(11):e0206850.

Yamanaka H. Japanese guideline for the management of hyperuricemia and gout: second edition. Nucleosides Nucleotides Nucleic Acids 2011;30(12):1018–29.

Atar AI, Yilmaz OC, Akin K, Selcoki Y, Er O, Eryonucu B. Serum uric acid level is an independent risk factor for presence of calcium in coronary arteries: an observational case-controlled study. Anadolu Kardiyol Derg 2013;13(2):139–45.

Tomiyama H, Higashi Y, Takase B, Node K, Sata M, Inoue T, et al. Relationships among hyperuricemia, metabolic syndrome, and endothelial function. Am J Hypertens 2011;24(7):770–4.

He C, Lin P, Liu W, Fang K. Prognostic value of hyperuricemia in patients with acute coronary syndrome: A meta-analysis. Eur J Clin Invest 2019;49(4):e13074.

Lopez-Pineda A, Cordero A, Carratala-Munuera C, Orozco-Beltran D, Quesada JA, Bertomeu-Gonzalez V, et al. Hyperuricemia as a prognostic factor after acute coronary syndrome. Atherosclerosis 2018;269:229–35.

Pagidipati NJ, Hess CN, Clare RM, Akerblom A, Tricoci P, Wojdyla D, et al. An examination of the relationship between serum uric acid level, a clinical history of gout, and cardiovascular outcomes among patients with acute coronary syndrome. Am Heart J 2017;187:53–61.

Bhattacharya PK, Agarwal M, Gautom D, Saikia H. Role of serum uric acid level in predicting outcome in acute myocardial infarction. Natl J Lab Med 2016;5(4):18–22.

Li L, Ma Y, Shang XM, Hong Y, Wang JH, Tan Z, et al. Hyperuricemia is associated with short-term outcomes in elderly patients with acute myocardial infarction. Aging Clin Exp Res 2018;30(10):1211–5.

Downloads

Published

2022-06-21

Most read articles by the same author(s)