Dataset Information

Impact of serum uric acid levels on the clinical prognosis and severity of coronary artery disease in patients with acute coronary syndrome and hypertension after percutaneous coronary intervention: a prospective cohort study.

ABSTRACT:

Objective

The impact of serum uric acid (sUA) levels on the clinical prognosis and severity of coronary artery disease in patients with acute coronary syndrome (ACS) and hypertension after percutaneous coronary intervention (PCI) is not fully clear. This study aimed to assess the association among sUA levels, clinical prognosis and severity of coronary artery disease in patients with ACS and hypertension after PCI.

Design

In this prospective cohort study, we followed-up patients with ACS and hypertension after PCI for 1 year to explore the risk factors for 1 year total major adverse cardiovascular events (MACEs) and multivessel coronary artery disease, the dose-effect relationship among sUA levels, MACEs and severity of coronary artery disease and correlation between sUA levels and severity of coronary artery disease (Gensini score).

Setting/patients

Several Chinese internists followed-up 422 patients who were diagnosed with ACS and hypertension after PCI in a large tertiary hospital of Qingdao during the period from 1 June 2019 to 1 December 2019.

Outcome measures

One-year follow-up MACEs results and coronary angiography results.

Results

In the coronary angiography results, multivessel coronary artery disease (28.5% vs 21.4%, p=0.006) and non-culprit lesion vascular occlusion (11.7% vs 5.3%, p=0.042) were more common in the hyperuricaemia group, and the Gensini score (26.69±13.46 vs 17.66±10.57, p<0.001) was also higher. In the results of 1-year MACEs, the incidence of all-cause mortality (3.5% vs 2.5%, p=0.037), PCI or coronary artery bypass grafting therapy due to myocardial infarction or angina pectoris (15.1% vs 7.6%, p=0.027), medication conservative therapy in hospital due to myocardial infarction or angina pectoris (12.9% vs 6.7%, p=0.041) and total MACEs (31.8% vs 16.9%, p=0.001) were higher in patients with hyperuricaemia. Univariate and multivariate logistic regression analysis models showed that hyperuricaemia was still an independent risk factor for total MACEs within 1 year (OR=2.618, 95% CI 1.656 to 4.139, p<0.001; OR=1.920, 95% CI 1.158 to 3.183, p=0.011, respectively) and multivessel coronary artery disease (OR=2.140, 95% CI 1.371 to 3.342, p=0.001; OR=1.688, 95% CI 1.051 to 2.710, p=0.030, respectively) after adjusting for confounding factors. The severity of coronary artery disease (non-culprit lesion vascular occlusion (4.7% vs 8.4% vs 9.6% vs 16.2%, p=0.041); multivessel coronary artery disease (17.9% vs 22.4% vs 29.8% vs 35.2%, p=0.022); Gensini score (16.96±10.35 vs 19.31±10.63 vs 26.12±11.48 vs 33.33±14.01, p<0.001)) and the incidence of total MACEs (13.2% vs 14.2% vs 34.6% vs 41%, p<0.001) increased significantly with the sUA levels increasing. Further, the Gensini score was positively correlated with uric acid levels (r=0.515, p<0.001).

Conclusions

Hyperuricaemia is an independent risk factor for 1-year total MACEs and multivessel coronary artery disease in patients with ACS and hypertension after PCI.

SUBMITTER: Zhang S

PROVIDER: S-EPMC8756275 | biostudies-literature |

REPOSITORIES: biostudies-literature

ACCESS DATA

Similar Datasets

Project description:BackgroundFibrinogen is a potential risk factor for the prognosis of CAD and is associated with the complexity of CAD. There is limited research specifically investigating the predictive role of fibrinogen in determining the severity of CAD among patients with T2DM, as well as its impact on the prognosis following PCI.MethodsThe study included 675 T2DM patients who underwent PCI at the Third People's Hospital of Chengdu between April 27, 2018, and February 5, 2021, with 540 of them remaining after exclusions. The complexity of CAD was assessed using the SYNTAX score. The primary endpoint of the study was the incidence of MACCEs.ResultsAfter adjusting for multiple confounding factors, fibrinogen remained a significant independent risk factor for mid/high SYNTAX scores (SYNTAX score > 22, OR 1.184, 95% CI 1.022-1.373, P = 0.025). Additionally, a dose-response relationship between fibrinogen and the risk of complicated CAD was observed (SYNTAX score > 22; nonlinear P = 0.0043). The area under the receiver operating characteristic curve(AUROC) of fibrinogen for predicting mid/high SYNTAX score was 0.610 (95% CI 0.567-0.651, P = 0.0002). The high fibrinogen group (fibrinogen > 3.79 g/L) had a higher incidence of calcified lesions and an elevated trend of more multivessel disease and chronic total occlusion. A total of 116 patients (21.5%) experienced MACCEs during the median follow-up time of 18.5 months. After adjustment, multivariate Cox regression analysis confirmed that fibrinogen (HR, 1.138; 95% CI 1.010-1.284, P = 0.034) remained a significant independent risk factor for MACCEs. The AUROC of fibrinogen for predicting MACCEs was 0.609 (95% CI 0.566-0.650, P = 0.0002). Individuals with high fibrinogen levels (fibrinogen > 4.28 g/L) had a higher incidence of acute myocardial infarction (P < 0.001), MACCEs (P < 0.001), all-cause death (P < 0.001), stroke (P = 0.030), and cardiac death (P = 0.002). Kaplan-Meier analysis revealed a higher incidence of MACCEs in the high fibrinogen group (Log-Rank test: P < 0.001).ConclusionsElevated fibrinogen levels were associated with increased coronary anatomical complexity (as quantified by the SYNTAX score) and a higher incidence of MACCEs after PCI in patients with T2DM.

Project description:BackgroundThe relationship between galectin-3 (Gal-3) and coronary artery disease (CAD) has not been fully elucidated.AimThis study aimed to determine the relationship between the presence and severity of CAD and serum Gal-3 levels.Patients and methodsThree-hundred thirty-one consecutive CAD patients were enrolled as the study group. An additional 62 patients without CAD were enrolled as the control group. Serum Gal-3 levels were separately compared between the non-CAD and CAD groups, among the stable CAD and Acute coronary syndrome (ACS) groups, and between CAD patients with low and high SYNTAX scores (SSs). The 1-year cumulative rate of major adverse cardiac events (MACEs) was also compared among ACS patients by Gal-3 levels.ResultsSerum Gal-3 was significantly higher in the CAD group than in the non-CAD group 3.89 (0.16-63.67) vs. 2.07 (0.23-9.38) ng/ml, P < 0.001. Furthermore, serum Gal-3 was significantly higher in the non-ST-segment elevation ACS (NSTE-ACS) group than that in the stable CAD group, 4.72 (1.0-16.14) vs. 2.23 (0.65-23.8) ng/ml, P = 0.04 and higher in the ST-segment elevation myocardial infarction (STEMI) group than that in the stable CAD group 7.87 (0.59-63.67) vs. 2.23 (0.65-23.8) ng/ml, P < 0.001. Serum Gal-3 level was an independent predictor of ACS compared with stable CAD group (OR = 1.131, 95% CI: 1.051-1.217, P = 0.001) as well as high SS (OR = 1.030, 95% CI: 1.021-1.047, P = 0.038) after adjust other confounding risk factors. Acute coronary syndrome patients with Gal-3 levels above the median (gal-3 = 4.78 ng/ml) showed a higher cumulative MACE rate than those with Gal-3 levels below the median. After adjusting other confounding risk factors, Gal-3 remained an independent risk factor for the cumulative rate of MACEs in ACS patients (6% higher rate of MACEs incidence per 1 ng/ml increment of Gal-3).ConclusionGalectin-3 correlated with the presence of CAD as well as coronary stability and complexity. Galectin-3 may be valuable in predicting mid-term prognosis in ACS patients.