| Abstract | Cilj. Ispitati prediktivnost razine serumske mokraćne kiseline (SMK) izmjerene na prijemu na 30-dnevne ishode (mortalitet i incidenciju velikih kardijalnih događaja (MACE) i dugoročno preživljenje (smrtnost svih uzroka) kod bolesnika sa akutnim infarktom miokarda (AIM). ----- Ispitanici i metode. Ova retrospektivna prognostička studija uključila je uzastopne bolesnike s dijagnosticiranim AIM (sa ili bez ST elevacije; STEMI/NSTEMI) zaprimljene u Opću bolnicu Varaždin unutar 48 sati od početka simptoma između 01.01.1996. i 31.12.2001. godine. ----- Rezultati. Uključeno je 613 bolesnika (dobi 27-90 godina, 64,6% muškaraca, 77,3% STEMI, SMK 63-993 µmol/l). Viša SMK, a posebno hiperuricemija (SMK>420 kod muškaraca i >360 µmol/L kod žena) neovisno je bila povezana sa višim 30-dnevnim mortalitetom (RR=1.87, 95% CI 1.25-2.81) i incidencijom MACE (RR= 1.79, 1.26-2.55). Analiza podgrupa pokazala je tu povezanost kod STEMI, NSTEMI, muškaraca i žena. Hiperuricemija je također neovisno povezana sa višom 30-dnevnom smrtnosti kod bolesnika sa srednje teško do teško sniženom glomerularnom filtracijom (eGFR <60 mL/min/1.73 m2) (n=309, RR=2.24, 1.40-3.59, p<0.001), ali ne i kod onih sa urednom do blago sniženom eGFR (>ili=60 mL/min/1.73 m na 2) (n=304, RR=1.13, 0.26-4.87, p=867). Isto opažanje vrijedi i za MACE. Temeljeno na praćenju kroz 13 godina, viša SMK je povezana sa višom dugoročnom smrtnosti bilo kojeg uzroka nakon AIM (HR za 100 µmol/L SMK= 2.99, 1.49-6.57; HR za hiperuricemiju=32.9, 5.03-216). ----- Zaključak. Viša izmjerena SMK na prijemu (a posebno hiperuricemija) je snažan neovisni prediktor lošijeg 30-dnevnog ishoda u neselektiranih bolesnika sa AIM, kod bolesnika sa STEMI, bolesnika sa NSTEMI, muškaraca i žena. Ta veza je uvjetovana sa bubrežnom funkcijom: javlja se kod bolesnika sa srednje teško do teško sniženom eGFR ali ne i kod onih sa normalno do blago sniženom eGFR. SMK izmjerena na prijemu je također i snažan neovisni prediktor lošijeg dugoročnog preživljenja nakon AIM. SMK izmjerena na prijemu trebala bi postati važni faktor stratifikacije rizika kod bolesnika sa AIM. |
| Abstract (english) | Objectives. To assess predictivity of serum uric acid (SUA) levels determined on admission for 30-day outcomes (mortality and incidence of major adverse cardiac events [MACE]) and long-term outcomes (all-cause mortality) in acute myocardial infarction (AMI) patients. ----- Patients and Methods. This retrospective prognostic study included consecutive patients with verified AMI (with/without ST elevation; STEMI/NSTEMI) admitted to the Varaždin County General Hospital within 48 hours since the symptom onset, between January 1 1996 and December 31 2001. ----- Results. A total of 613 patients (age 27-90 years, 64.6% men, 77.3% STEMI, SUA 63-993 µmol/l) were included. Higher SUA, and particularly, hyperuricemia (SUA >420 in men >360 µmol/L in women) was independently associated with higher 30-day mortality (RR=1.87, 95% CI 1.25-2.81) and incidence of MACE (RR= 1.79, 1.26-2.55). Subgroup analysis confirmed this relationship in STEMI, NSTEMI, men and women. Hyperuricemia was also independently associated with higher 30-day mortality in patients with moderately to severely reduced glomerular filtration rate (eGFR <60 mL/min/1.73 m2) (n=309, RR=2.24, 1.40-3.59, p<0.001), but not in those with normal to mildly reduced eGFR (>or=60 mL/min/1.73 m to 2) (n=304, RR=1.13, 0.26-4.87, p=867). The same was observed regarding the incidence of MACE. Based on a 13-year observational period, higher SUA was associated with higher long-term all-cause mortality after AMI (HR by 100 µmol/L SUA= 2.99, 1.49-6.57; HR for hyperuricemia=32.9, 5.03-216). ----- Conclusion. Higher SUA on admission (and particularly, hyperuricemia) is a strong independent predictor of poor 30-day outcomes in unselected patients with AMI, in patients with STEMI, patients with NSTEMI, men or women. This association is conditional on renal function: it holds in patients with moderately to severely reduced eGFR but seemingly not in patients with normal to mildly reduced eGFR. Also, higher on-admission SUA is a strong independent predictor of poor long-term survival after AMI. On-admission SUA should be considered as an important factor in risk stratification in AMI patients. |
