Hyperuricemia as a prognostic factor after acute coronary syndrome
Many studies have reported the independent association between uric acid and cardiovascular disease, its role as a risk predictor for outcomes in people with acute coronary syndrome remains controversial. This study aims to assess the association between hyperuricemia and medium/long-term clinical o...
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| Veröffentlicht in: | Atherosclerosis 2018-02, Vol.269, p.229-235 |
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| creator | Lopez-Pineda, Adriana Cordero, Alberto Carratala-Munuera, Concepción Orozco-Beltran, Domingo Quesada, Jose A. Bertomeu-Gonzalez, Vicente Gil-Guillen, Vicente F. Bertomeu-Martinez, Vicente |
| description | Many studies have reported the independent association between uric acid and cardiovascular disease, its role as a risk predictor for outcomes in people with acute coronary syndrome remains controversial. This study aims to assess the association between hyperuricemia and medium/long-term clinical outcomes in people with acute coronary syndrome and determine whether adding hyperuricemia to the GRACE score improves its predictive capability.
This cohort study included patients admitted for acute coronary syndrome between 2008 and 2013. Outcomes were cardiovascular and total mortality, and major cardiovascular events. We used a multivariate model to adjust for potential confounding covariates and presented event rates with Kaplan-Meier curves. After adding hyperuricemia to the GRACE score, we compared scores from the reclassification table and the net reclassification improvement.
1119 participants were included and followed-up for a mean of 36 months. Multivariate models showed hyperuricemia was independently associated with higher cardiovascular mortality (HR:1.91; 95% CI:1.32–2.76; p |
| doi_str_mv | 10.1016/j.atherosclerosis.2018.01.017 |
| format | Article |
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This cohort study included patients admitted for acute coronary syndrome between 2008 and 2013. Outcomes were cardiovascular and total mortality, and major cardiovascular events. We used a multivariate model to adjust for potential confounding covariates and presented event rates with Kaplan-Meier curves. After adding hyperuricemia to the GRACE score, we compared scores from the reclassification table and the net reclassification improvement.
1119 participants were included and followed-up for a mean of 36 months. Multivariate models showed hyperuricemia was independently associated with higher cardiovascular mortality (HR:1.91; 95% CI:1.32–2.76; p < 0.01), higher all-cause mortality (HR:1.59; 95% CI:1.18–2.15; p < 0.01) and higher major cardiovascular event rates (HR:1.36; 95% CI:1.11–1.67; p < 0.01). The hyperuricemia addition to GRACE score led to reclassifying 26% of the participants, and net reclassification improvement was 34%. However, the area under the curve increase was 0.009 and not statistically significant (p > 0.05).
Hyperuricemia is associated with higher medium/long-term mortality and major cardiovascular event rates in patients following acute coronary syndrome. The addition of hyperuricemia to the GRACE score seems to improve risk classification but the discrimination of the new predictive model did not change. Hyperuricemic patients had higher all-cause mortality in medium and high-risk score categories.
•Hyperuricemia is independently associated with poor clinical outcomes after ACS.•If GRACE score includes hyperuricemia, risk classification for non-events improves.•It is known serum uric acid level is an inexpensive and commonly ordered measure.•Uric acid level might help stratify risk for poor outcomes after ACS.</description><identifier>ISSN: 0021-9150</identifier><identifier>EISSN: 1879-1484</identifier><identifier>DOI: 10.1016/j.atherosclerosis.2018.01.017</identifier><identifier>PMID: 29407598</identifier><language>eng</language><publisher>Ireland: Elsevier B.V</publisher><subject>Acute coronary syndrome ; Acute Coronary Syndrome - blood ; Acute Coronary Syndrome - diagnosis ; Acute Coronary Syndrome - mortality ; Acute Coronary Syndrome - therapy ; Aged ; Aged, 80 and over ; Biomarkers - blood ; Cardiology ; Decision Support Techniques ; Female ; Humans ; Hyperuricemia ; Hyperuricemia - blood ; Hyperuricemia - diagnosis ; Hyperuricemia - mortality ; Male ; Middle Aged ; Percutaneous Coronary Intervention - adverse effects ; Percutaneous Coronary Intervention - mortality ; Predictive Value of Tests ; Prevalence ; Prospective Studies ; Registries ; Risk Assessment ; Risk Factors ; Spain - epidemiology ; Time Factors ; Treatment Outcome ; Up-Regulation ; Uric acid ; Uric Acid - blood</subject><ispartof>Atherosclerosis, 2018-02, Vol.269, p.229-235</ispartof><rights>2018 Elsevier B.V.</rights><rights>Copyright © 2018 Elsevier B.V. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c415t-a73b2e1034b5a7bd6673a661b095bc6bf586159404e6f8a035dea7237003e0373</citedby><cites>FETCH-LOGICAL-c415t-a73b2e1034b5a7bd6673a661b095bc6bf586159404e6f8a035dea7237003e0373</cites><orcidid>0000-0002-2117-0178 ; 0000-0003-0000-7109 ; 0000-0001-5309-0562</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0021915018300170$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29407598$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lopez-Pineda, Adriana</creatorcontrib><creatorcontrib>Cordero, Alberto</creatorcontrib><creatorcontrib>Carratala-Munuera, Concepción</creatorcontrib><creatorcontrib>Orozco-Beltran, Domingo</creatorcontrib><creatorcontrib>Quesada, Jose A.</creatorcontrib><creatorcontrib>Bertomeu-Gonzalez, Vicente</creatorcontrib><creatorcontrib>Gil-Guillen, Vicente F.</creatorcontrib><creatorcontrib>Bertomeu-Martinez, Vicente</creatorcontrib><title>Hyperuricemia as a prognostic factor after acute coronary syndrome</title><title>Atherosclerosis</title><addtitle>Atherosclerosis</addtitle><description>Many studies have reported the independent association between uric acid and cardiovascular disease, its role as a risk predictor for outcomes in people with acute coronary syndrome remains controversial. This study aims to assess the association between hyperuricemia and medium/long-term clinical outcomes in people with acute coronary syndrome and determine whether adding hyperuricemia to the GRACE score improves its predictive capability.
This cohort study included patients admitted for acute coronary syndrome between 2008 and 2013. Outcomes were cardiovascular and total mortality, and major cardiovascular events. We used a multivariate model to adjust for potential confounding covariates and presented event rates with Kaplan-Meier curves. After adding hyperuricemia to the GRACE score, we compared scores from the reclassification table and the net reclassification improvement.
1119 participants were included and followed-up for a mean of 36 months. Multivariate models showed hyperuricemia was independently associated with higher cardiovascular mortality (HR:1.91; 95% CI:1.32–2.76; p < 0.01), higher all-cause mortality (HR:1.59; 95% CI:1.18–2.15; p < 0.01) and higher major cardiovascular event rates (HR:1.36; 95% CI:1.11–1.67; p < 0.01). The hyperuricemia addition to GRACE score led to reclassifying 26% of the participants, and net reclassification improvement was 34%. However, the area under the curve increase was 0.009 and not statistically significant (p > 0.05).
Hyperuricemia is associated with higher medium/long-term mortality and major cardiovascular event rates in patients following acute coronary syndrome. The addition of hyperuricemia to the GRACE score seems to improve risk classification but the discrimination of the new predictive model did not change. Hyperuricemic patients had higher all-cause mortality in medium and high-risk score categories.
•Hyperuricemia is independently associated with poor clinical outcomes after ACS.•If GRACE score includes hyperuricemia, risk classification for non-events improves.•It is known serum uric acid level is an inexpensive and commonly ordered measure.•Uric acid level might help stratify risk for poor outcomes after ACS.</description><subject>Acute coronary syndrome</subject><subject>Acute Coronary Syndrome - blood</subject><subject>Acute Coronary Syndrome - diagnosis</subject><subject>Acute Coronary Syndrome - mortality</subject><subject>Acute Coronary Syndrome - therapy</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Biomarkers - blood</subject><subject>Cardiology</subject><subject>Decision Support Techniques</subject><subject>Female</subject><subject>Humans</subject><subject>Hyperuricemia</subject><subject>Hyperuricemia - blood</subject><subject>Hyperuricemia - diagnosis</subject><subject>Hyperuricemia - mortality</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Percutaneous Coronary Intervention - adverse effects</subject><subject>Percutaneous Coronary Intervention - mortality</subject><subject>Predictive Value of Tests</subject><subject>Prevalence</subject><subject>Prospective Studies</subject><subject>Registries</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Spain - epidemiology</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>Up-Regulation</subject><subject>Uric acid</subject><subject>Uric Acid - blood</subject><issn>0021-9150</issn><issn>1879-1484</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkDFPwzAQhS0EoqXwF1AWJJaUuySOk4EBKihIlVhgthznAq6auNgJUv89jloYmJBOd8u7e-8-xq4Q5giY36znqv8gZ73ejN34eQJYzAFDiSM2xUKUMWZFdsymAAnGJXKYsDPv1wCQCSxO2SQpMxC8LKbs_mm3JTc4o6k1KlI-UtHW2ffO-t7oqFG6ty5STU-h66GnSFtnO-V2kd91tbMtnbOTRm08XRzmjL09PrwunuLVy_J5cbeKdYa8j5VIq4QQ0qziSlR1notU5TlWUPJK51XDixx5CJZR3hQKUl6TEkkqAFKCVKQzdr2_G_J9DuR72RqvabNRHdnBSyzLEsO3yIP0di_VAZF31MitM20ILRHkiFGu5R-McsQoAUONVpcHq6Fqqf7d_uEWBMu9gMLDX4ac9NpQp6k2jnQva2v-afUN1CeNcw</recordid><startdate>20180201</startdate><enddate>20180201</enddate><creator>Lopez-Pineda, Adriana</creator><creator>Cordero, Alberto</creator><creator>Carratala-Munuera, Concepción</creator><creator>Orozco-Beltran, Domingo</creator><creator>Quesada, Jose A.</creator><creator>Bertomeu-Gonzalez, Vicente</creator><creator>Gil-Guillen, Vicente F.</creator><creator>Bertomeu-Martinez, Vicente</creator><general>Elsevier B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-2117-0178</orcidid><orcidid>https://orcid.org/0000-0003-0000-7109</orcidid><orcidid>https://orcid.org/0000-0001-5309-0562</orcidid></search><sort><creationdate>20180201</creationdate><title>Hyperuricemia as a prognostic factor after acute coronary syndrome</title><author>Lopez-Pineda, Adriana ; Cordero, Alberto ; Carratala-Munuera, Concepción ; Orozco-Beltran, Domingo ; Quesada, Jose A. ; Bertomeu-Gonzalez, Vicente ; Gil-Guillen, Vicente F. ; Bertomeu-Martinez, Vicente</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c415t-a73b2e1034b5a7bd6673a661b095bc6bf586159404e6f8a035dea7237003e0373</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Acute coronary syndrome</topic><topic>Acute Coronary Syndrome - blood</topic><topic>Acute Coronary Syndrome - diagnosis</topic><topic>Acute Coronary Syndrome - mortality</topic><topic>Acute Coronary Syndrome - therapy</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Biomarkers - blood</topic><topic>Cardiology</topic><topic>Decision Support Techniques</topic><topic>Female</topic><topic>Humans</topic><topic>Hyperuricemia</topic><topic>Hyperuricemia - blood</topic><topic>Hyperuricemia - diagnosis</topic><topic>Hyperuricemia - mortality</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Percutaneous Coronary Intervention - adverse effects</topic><topic>Percutaneous Coronary Intervention - mortality</topic><topic>Predictive Value of Tests</topic><topic>Prevalence</topic><topic>Prospective Studies</topic><topic>Registries</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Spain - epidemiology</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>Up-Regulation</topic><topic>Uric acid</topic><topic>Uric Acid - blood</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lopez-Pineda, Adriana</creatorcontrib><creatorcontrib>Cordero, Alberto</creatorcontrib><creatorcontrib>Carratala-Munuera, Concepción</creatorcontrib><creatorcontrib>Orozco-Beltran, Domingo</creatorcontrib><creatorcontrib>Quesada, Jose A.</creatorcontrib><creatorcontrib>Bertomeu-Gonzalez, Vicente</creatorcontrib><creatorcontrib>Gil-Guillen, Vicente F.</creatorcontrib><creatorcontrib>Bertomeu-Martinez, Vicente</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Atherosclerosis</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lopez-Pineda, Adriana</au><au>Cordero, Alberto</au><au>Carratala-Munuera, Concepción</au><au>Orozco-Beltran, Domingo</au><au>Quesada, Jose A.</au><au>Bertomeu-Gonzalez, Vicente</au><au>Gil-Guillen, Vicente F.</au><au>Bertomeu-Martinez, Vicente</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Hyperuricemia as a prognostic factor after acute coronary syndrome</atitle><jtitle>Atherosclerosis</jtitle><addtitle>Atherosclerosis</addtitle><date>2018-02-01</date><risdate>2018</risdate><volume>269</volume><spage>229</spage><epage>235</epage><pages>229-235</pages><issn>0021-9150</issn><eissn>1879-1484</eissn><abstract>Many studies have reported the independent association between uric acid and cardiovascular disease, its role as a risk predictor for outcomes in people with acute coronary syndrome remains controversial. This study aims to assess the association between hyperuricemia and medium/long-term clinical outcomes in people with acute coronary syndrome and determine whether adding hyperuricemia to the GRACE score improves its predictive capability.
This cohort study included patients admitted for acute coronary syndrome between 2008 and 2013. Outcomes were cardiovascular and total mortality, and major cardiovascular events. We used a multivariate model to adjust for potential confounding covariates and presented event rates with Kaplan-Meier curves. After adding hyperuricemia to the GRACE score, we compared scores from the reclassification table and the net reclassification improvement.
1119 participants were included and followed-up for a mean of 36 months. Multivariate models showed hyperuricemia was independently associated with higher cardiovascular mortality (HR:1.91; 95% CI:1.32–2.76; p < 0.01), higher all-cause mortality (HR:1.59; 95% CI:1.18–2.15; p < 0.01) and higher major cardiovascular event rates (HR:1.36; 95% CI:1.11–1.67; p < 0.01). The hyperuricemia addition to GRACE score led to reclassifying 26% of the participants, and net reclassification improvement was 34%. However, the area under the curve increase was 0.009 and not statistically significant (p > 0.05).
Hyperuricemia is associated with higher medium/long-term mortality and major cardiovascular event rates in patients following acute coronary syndrome. The addition of hyperuricemia to the GRACE score seems to improve risk classification but the discrimination of the new predictive model did not change. Hyperuricemic patients had higher all-cause mortality in medium and high-risk score categories.
•Hyperuricemia is independently associated with poor clinical outcomes after ACS.•If GRACE score includes hyperuricemia, risk classification for non-events improves.•It is known serum uric acid level is an inexpensive and commonly ordered measure.•Uric acid level might help stratify risk for poor outcomes after ACS.</abstract><cop>Ireland</cop><pub>Elsevier B.V</pub><pmid>29407598</pmid><doi>10.1016/j.atherosclerosis.2018.01.017</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-2117-0178</orcidid><orcidid>https://orcid.org/0000-0003-0000-7109</orcidid><orcidid>https://orcid.org/0000-0001-5309-0562</orcidid></addata></record> |
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| subjects | Acute coronary syndrome Acute Coronary Syndrome - blood Acute Coronary Syndrome - diagnosis Acute Coronary Syndrome - mortality Acute Coronary Syndrome - therapy Aged Aged, 80 and over Biomarkers - blood Cardiology Decision Support Techniques Female Humans Hyperuricemia Hyperuricemia - blood Hyperuricemia - diagnosis Hyperuricemia - mortality Male Middle Aged Percutaneous Coronary Intervention - adverse effects Percutaneous Coronary Intervention - mortality Predictive Value of Tests Prevalence Prospective Studies Registries Risk Assessment Risk Factors Spain - epidemiology Time Factors Treatment Outcome Up-Regulation Uric acid Uric Acid - blood |
| title | Hyperuricemia as a prognostic factor after acute coronary syndrome |
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