Uric acid for diagnosis and risk stratification in suspected myocardial infarction

Medientyp: E-Artikel
Titel: Uric acid for diagnosis and risk stratification in suspected myocardial infarction
Beteiligte: Wildi, Karin; Haaf, Philip; Reichlin, Tobias; Acemoglu, Resat; Schneider, Jeannine; Balmelli, Cathrin; Drexler, Beatrice; Twerenbold, Raphael; Mosimann, Tamina; Reiter, Miriam; Mueller, Mira; Ernst, Susanne; Ballarino, Paola; Zellweger, Christa; Moehring, Berit; Vilaplana, Carles; Freidank, Heike; Mueller, Christian
Erschienen: Wiley, 2013
Erschienen in: European Journal of Clinical Investigation
Sprache: Englisch
DOI: 10.1111/eci.12029
ISSN: 1365-2362; 0014-2972
Schlagwörter: Clinical Biochemistry ; Biochemistry ; General Medicine
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Beschreibung: <jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>Hypoxia precedes cardiomyocyte necrosis in acute myocardial infarction (<jats:styled-content style="fixed-case">AMI</jats:styled-content>). We therefore hypothesized that uric acid – as a marker of oxidative stress and hypoxia – might be useful in the early diagnosis and risk stratification of patients with suspected <jats:styled-content style="fixed-case">AMI</jats:styled-content>.</jats:p></jats:sec><jats:sec><jats:title>Materials and methods</jats:title><jats:p>In this prospective observational study, uric acid was measured at presentation in 892 consecutive patients presenting to the emergency department with suspected <jats:styled-content style="fixed-case">AMI</jats:styled-content>. The final diagnosis was adjudicated by two independent cardiologists. Patients were followed 24 months regarding mortality. Primary outcome was the diagnosis of <jats:styled-content style="fixed-case">AMI</jats:styled-content>, secondary outcome was short‐ and long‐term mortality.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Uric acid at presentation was higher in patients with <jats:styled-content style="fixed-case">AMI</jats:styled-content> than in patients without (372 μM vs. 336 μM; <jats:italic>P</jats:italic> < 0·001). The diagnostic accuracy of uric acid for <jats:styled-content style="fixed-case">AMI</jats:styled-content> as quantified by the area under the receiver operating characteristic curve (<jats:styled-content style="fixed-case">AUC</jats:styled-content>) was 0·60 (95%Cl 0·56–0·65). When added to cardiac troponin T (<jats:styled-content style="fixed-case">cTnT</jats:styled-content>), uric acid significantly increased the <jats:styled-content style="fixed-case">AUC</jats:styled-content> of <jats:styled-content style="fixed-case">cTnT</jats:styled-content> from 0·89 (95%Cl 0·85–0·93) to 0·92 (95%Cl 0·89–0·95, <jats:italic>P</jats:italic> = 0·020 for comparison). Cumulative 24‐month mortality rates were 2·2% in the first, 5·4% in the second and the third and 15·6% in the fourth quartile of uric acid (<jats:italic>P</jats:italic> < 0·001 for log‐rank). Uric acid predicted 24‐month mortality independently. Adding uric acid to <jats:styled-content style="fixed-case">TIMI</jats:styled-content> and <jats:styled-content style="fixed-case">GRACE</jats:styled-content> risk score improved their prognostic accuracy as shown by an integrated discrimination improvement of 0·04 (<jats:italic>P</jats:italic> = 0·007) respective 0·02 (<jats:italic>P</jats:italic> = 0·021).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Uric acid, an inexpensive widely available biomarker, improves both the early diagnosis and risk stratification of patients with suspected <jats:styled-content style="fixed-case">AMI</jats:styled-content>.</jats:p></jats:sec>

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