HYPERURICEMIA IN ACUTE MYOCARDIAL INFARCTION : THE IMPACT ON IN-HOSPITAL MORBIDITY AND MORTALITY

Aims: To investigate the incidence of elevated values of serum uric acid (UA)  concentration in patients with acute myocardial infarction (AMI) and assess its impact on in-hospital morbidity and mortality.
Methods: We analyzed the course of AMI in 289 patients (141 or 68.8% male; mean age 66.2±12.1 years; mean hospital stay 13.3±5.8 days) admitted to the Coronary Care Unit during the year 2003. Clinical and therapeutic variables were analyzed. Patients with raised (>410 μmol/l, n=84) and normal UA concentration were compared to determine the predictive value of UA on end-point events (death, acute cardiac failure, non-fatal reinfarction, early post-infarction angina). Receiver operating characteristic (ROC) curves were carried out.  
Results: Patients with elevated UA (mean value 525±71.1 μmol/l) showed more often  signs of heart failure - KillipII (31.0% vs. 11.7%; P=0.0002) and Killip III-IV (22.6% vs. 6.3%; P=0.0001). They had a higher in-hospital mortality rate (16.7% vs. 7.8%; P=0.041). ROC analysis demonstrated that increased UA predicted more frequent composite end-point (death, heart failure). Cut off value 407 μmol/l; AUC 0.700;  SE 0.036 (95% CI = 0.643 to 0.753). Odds ratio 4.85 (95% CI= 2.775 – 8.462). Sensitivity of a test was 54.3 and specifisity 80,8.
Conclusions: One third of patients with acute myocardial infarction had elevated serum uric acid concentration. In that group the course was more often complicated by signs of cardiac failure and death. Our results suggest that serum uric acid concentration in acute myocardial infarction is a suitable predictive marker  of a complicating early course of  the disease.