title: Prognostic usefulness of serum uric acid after acute myocardial infarction (the Japanese Acute Coronary Syndrome Study).
abstract: Serum uric acid (UA) levels reflect circulating xanthine oxidase activity and oxidative stress production. Hyperuricemia has been identified in patients who have congestive heart failure and is a marker of poor prognosis in such patients. We investigated the relation between serum UA levels and Killip's classification suggestive of the severity of heart failure and whether hyperuricemia influences mortality of patients who have acute myocardial infarction (AMI). Using the Japanese Acute Coronary Syndrome Study database, we evaluated 1,124 consecutive patients who were hospitalized within 48 hours of onset of symptoms of AMI from January to December 2002. There was a close relation between serum UA concentration and Killip's classification. Patients who developed short-term adverse events had high UA concentrations. Serum UA levels, Killip's class, age, and peak creatine phosphokinase level were significant predictors of long-term mortality. The hazard ratio for patients in the highest quartile of UA was 3.7 compared with those in the lowest quartile for death after AMI after adjustment for independent factors that were related to mortality. The combination of the best UA cutoff (447 micromol/L) for predicting survival based on receiver-operating characteristics analysis and Killip's class significantly predicted the prognosis of acute and long-term AMI-related complications. In conclusion, our results suggest that hyperuricemia after AMI is associated with the development of heart failure. Serum UA level is a suitable marker for predicting AMI-related future adverse events, and the combination of Killip's class and serum UA level after AMI is a good predictor of mortality in patients who have AMI.
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan. kojimas@kumamoto-u.ac.jp
authors.forename: Sunao
authors.initials: S
authors.lastname: Kojima
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Sakamoto
authors.forename: Masaharu
authors.initials: M
authors.lastname: Ishihara
authors.forename: Kazuo
authors.initials: K
authors.lastname: Kimura
authors.forename: Shunichi
authors.initials: S
authors.lastname: Miyazaki
authors.forename: Masakazu
authors.initials: M
authors.lastname: Yamagishi
authors.forename: Chuwa
authors.initials: C
authors.lastname: Tei
authors.forename: Hisatoyo
authors.initials: H
authors.lastname: Hiraoka
authors.forename: Masahiro
authors.initials: M
authors.lastname: Sonoda
authors.forename: Kazufumi
authors.initials: K
authors.lastname: Tsuchihashi
authors.forename: Nobuo
authors.initials: N
authors.lastname: Shimoyama
authors.forename: Takashi
authors.initials: T
authors.lastname: Honda
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Ogata
authors.forename: Kunihiko
authors.initials: K
authors.lastname: Matsui
authors.forename: Hisao
authors.initials: H
authors.lastname: Ogawa
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D017023:Coronary Angiography; D003402:Creatine Kinase / Q000097:blood; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood / Q000145:classification / Q000401:mortality; D006801:Humans; D033461:Hyperuricemia / Q000097:blood / Q000150:complications; D007564:Japan / Q000453:epidemiology; D008297:Male; D009203:Myocardial Infarction / Q000097:blood* / Q000150:complications / Q000000981:diagnostic imaging; D019370:Observation; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014527:Uric Acid / Q000097:blood*
chemical_list: D015415:Biomarkers; D014527:Uric Acid; D003402:Creatine Kinase