Association between serum uric acid and perioperative and late cardiovascular outcome in patients with suspected or definite coronary artery disease undergoing elective vascular surgery.
The role of uric acid as an independent marker of cardiovascular risk is unclear. Therefore, our aim was to assess the independent contribution of preoperative serum uric acid levels to the risk of 30-day and late mortality and major adverse cardiac event (MACE) in patients scheduled for open vascular surgery. In total, 936 patients (76% male, age 68 +/- 11 years) were enrolled. Hyperuricemia was defined as serum uric acid >0.42 mmol/l for men and >0.36 mmol/l for women, as defined by large epidemiological studies. Outcome measures were 30-day and late mortality and MACE (cardiac death or myocardial infarction). Multivariable logistic and Cox regression analysis were used, adjusting for age, gender, and all cardiac risk factors. Data are presented as odds ratios or hazard ratios, with 95% confidence intervals. Hyperuricemia was present in 299 patients (32%). The presence of hyperuricemia was associated with heart failure, chronic kidney disease, and the use of diuretics. Perioperatively, 46 patients (5%) died and 61 patients (7%) experienced a MACE. Mean follow-up was 3.7 years (range: 0 to 17 years). During follow-up, 282 patients (30%) died and 170 patients (18%) experienced a MACE. After adjustment for all clinical risk factors, the presence of hyperuricemia was not significantly associated with an increased risk of 30-day mortality or MACE, odds ratios of 1.5 (0.8 to 2.8) and 1.7 (0.9 to 3.0), respectively. However, the presence of hyperuricemia was associated with an increased risk of late mortality and MACE, with hazard ratios of 1.4 (1.1 to 1.7) and 1.7 (1.3 to 2.3), respectively. In conclusion, the presence of preoperative hyperuricemia in vascular patients is a significant predictor of late mortality and MACE.
Dunkelgrun
Martin
M
Department of Vascular Surgery, Erasmus Medical Centre, Rotterdam, the Netherlands.
Welten
Gijs M J M
GM
Goei
Dustin
D
Winkel
Tamara A
TA
Schouten
Olaf
O
van Domburg
Ron T
RT
van Gestel
Yvette R B M
YR
Flu
Willem-Jan
WJ
Hoeks
Sanne E
SE
Bax
Jeroen J
JJ
Poldermans
Don
D
D000368:Aged; D015415:Biomarkers / Q000097:blood; D003324:Coronary Artery Disease / Q000097:blood* / Q000401:mortality*; D017558:Elective Surgical Procedures / Q000401:mortality; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D014527:Uric Acid / Q000097:blood*; D014656:Vascular Surgical Procedures / Q000401:mortality*
D015415:Biomarkers; D014527:Uric Acid