title: Serum uric acid is associated with mortality and heart failure hospitalizations in patients with complicated myocardial infarction: findings from the High-Risk Myocardial Infarction Database Initiative.
abstract: OBJECTIVE
  Serum uric acid (SUA) levels are associated with poorer outcomes in healthy cohorts and patients with stable and unstable coronary heart disease. We investigated the relationship between SUA and clinical outcomes in subjects with acute myocardial infarction (MI) complicated by reduced left ventricular (LV) function, heart failure (HF), or both.
  
  
  RESULTS
  Univariable and multivariable Cox proportional hazards modelling was performed to study the association of baseline SUA and all-cause mortality, cardiovascular (CV) mortality, and HF hospitalization in an individual patient meta-analysis of four merged large randomized trials (CAPRICORN, EPHESUS, OPTIMAAL, and VALIANT). Three trials (excluding VALIANT) reported SUA, which was available in a total of 12 677 subjects. The ranges of SUA for quartiles I-IV were 45-280, 281-344, 345-420, and 420-1640 mmol/L, respectively. While almost 90% of patients in the lowest SUA quartile were alive after a mean follow-up of 23 ± 11 months, <70% were alive in the highest SUA quartile. Compared with the lowest SUA quartile as reference, hazard ratios (HRs) and 95% confidence intervals (CIs) of SUA quartiles III and IV showed an increase in all-cause mortality [HR 1.18, 95% CI 0.95-1.46, and HR 1.36, 95% CI 1.11-1.67) and CV mortality (HR 1.27, 95% 1.01-1.61, and HR 1.47, 95% CI 1.17-1.83). SUA quartiles III and IV also exhibited increased HF hospitalization (HR 1.22, 95% CI 1.09-1.36, and HR 1.28, 95% CI 1.14-1.43; P < 0.001 for all comparisons) in multivariable analyses. The addition of SUA was associated with a significant improvement in reclassification to predict CV mortality (net reclassification improvement 17.6%, 95% CI 14.9-20.5%, P < 0.001).
  
  
  CONCLUSIONS
  Elevated SUA is associated with poor outcomes in patients after MI complicated by reduced LV function, HF, or both. The quantification of SUA, a low-cost routinely available biomarker, could improve risk stratification of patients with complicated MI.
authors.affiliation: Department of Cardiology B, Division of Medicine, Oslo University Hospital Ullevål, University of Oslo, Norway.|Center for Heart Failure Research, University of Oslo, Norway.
authors.forename: Thomas G
authors.initials: TG
authors.lastname: von Lueder
authors.affiliation: INSERM, Centre d'Investigations Cliniques-1433, and INSERM U1116, Nancy, France.|CHU Nancy, Institut Lorrain du Cœur et des Vaisseaux, Vandoeuvre lès Nancy, France.|Université de Lorraine, Nancy, France.|F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists) Network, Nancy, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Girerd
authors.affiliation: Department of Cardiology B, Division of Medicine, Oslo University Hospital Ullevål, University of Oslo, Norway.|Center for Heart Failure Research, University of Oslo, Norway.
authors.forename: Dan
authors.initials: D
authors.lastname: Atar
authors.affiliation: Department of Cardiology B, Division of Medicine, Oslo University Hospital Ullevål, University of Oslo, Norway.|Center for Heart Failure Research, University of Oslo, Norway.
authors.forename: Stefan
authors.initials: S
authors.lastname: Agewall
authors.affiliation: INSERM, Centre d'Investigations Cliniques-1433, and INSERM U1116, Nancy, France.|CHU Nancy, Institut Lorrain du Cœur et des Vaisseaux, Vandoeuvre lès Nancy, France.|Université de Lorraine, Nancy, France.|F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists) Network, Nancy, France.
authors.forename: Zohra
authors.initials: Z
authors.lastname: Lamiral
authors.affiliation: Department of Medicine, Division of Nephrology, Koc University School of Medicine, Istanbul, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Kanbay
authors.affiliation: University of Michigan School of Medicine, Ann Arbor, MI, USA.
authors.forename: Bertram
authors.initials: B
authors.lastname: Pitt
authors.affiliation: Division of Cardiology, University of Bergen, Stavanger University Hospital, Stavanger, Norway.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Dickstein
authors.affiliation: INSERM, Centre d'Investigations Cliniques-1433, and INSERM U1116, Nancy, France.|CHU Nancy, Institut Lorrain du Cœur et des Vaisseaux, Vandoeuvre lès Nancy, France.|Université de Lorraine, Nancy, France.|F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists) Network, Nancy, France.
authors.forename: Faiez
authors.initials: F
authors.lastname: Zannad
authors.affiliation: INSERM, Centre d'Investigations Cliniques-1433, and INSERM U1116, Nancy, France.|CHU Nancy, Institut Lorrain du Cœur et des Vaisseaux, Vandoeuvre lès Nancy, France.|Université de Lorraine, Nancy, France.|F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists) Network, Nancy, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Rossignol
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012307:Risk Factors; D013223:Statistics as Topic; D014527:Uric Acid / Q000097:blood*; D018487:Ventricular Dysfunction, Left / Q000097:blood / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology
chemical_list: D015415:Biomarkers; D014527:Uric Acid
keywords: Heart failure; Left ventricular dysfunction; Myocardial infarction; Uric acid