An Observational Study to Assess Outcome of NSTEMI Patients with Raised Serum Uric Acid Level in a Tertiary Care Hospital of Bangladesh
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Abstract
Background: Non-ST Segment Elevation Myocardial Infarction (NSTEMI) is the commonest form of ACS and a leading global cause of premature morbidity and mortality. Evidences link serum uric acid with short and long-term major adverse outcomes (MACE) in patients with NSTEMI.
Objective: To see in-hospital outcome of NSTEMI patients with raised serum uric acid level.
Methodology: This cross-sectional observational study was conducted in the Department of Cardiology, Sylhet MAG Osmani Medical College Hospital, Sylhet during the period from July, 2017 to June, 2019. Fifty NSTEMI patients with raised serum uric acid (>7mg/dl in male; >6mg/dl in female) level (Group A) and fifty NSTEMI patients with normal serum uric acid level (group B) admitted within 24 hours of symptom onset were consequently enrolled. In-hospital complications and mortality were recorded while continuing standard treatment for the event.
Results: The mean age was 60.82 (SD 9.62) years in group A and 49.90 (SD 10.40) years in group B. The mean age of the patients of group A was significantly higher than patients of Group B (p<0.001). Male preponderance was in both groups (84.0% versus 80.0%; p=0.603). Diabetes mellitus (52.0% versus 22.0%; p=0.002), hypertension (78.0% versus 52.0%; p=0.039) and dyslipidaemia (48.0% versus 12.0%; p<0.001) were more frequent in group A than that of group B. But smoking status (70.0% versus 66.0%; p=0.668), family history of CAD (10.0% versus 26.0%; p=0.476) did not differ significantly. Killip class did not differ significantly between group A and group B (p=0.127). In-hospital mortality was 5 (10.0%) patients in group A and 2 (4.0%) patients in group B; did not reach the level of significance (p>0.05) and complications such as post MI angina, cardiogenic shock, acute left ventricular failure, re-infarction, sinus tachycardia, sinus bradycardia, atrial flutter, atrial fibrillation, bundle branch block, ventricular tachycardia, ventricular fibrillation did not differ significantly between the two groups (p>0.05).
Conclusion: There is no significant difference between in-hospital outcome (mortality and complications) of NSTEMI patients with raised and normal serum uric acid level.
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Baber U, Holmes D, Halperin J, Fuster V (2017) Definitions of Acute Coronary Syndrome. In: Fuster V., Harrington RA, Narula J, Eapen ZJ, editors. Hurst’s The Heart.14th Ed. Vol. 1. USA: McGraw Hill 946-995.
O'Gara PT, Kushner FG, Ascheim DD, Casey DE, Chung MK, et al. (2013) American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. 2013. 2013 ACCF/AHA guideline for the management of ST elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 127: e362-425. Link: https://bit.ly/2WYIuAU
Molitemo DJ, Januzzi JL (2017) Evaluation and management of Non –ST-segment elevation Myocardial Infarction. In: Fuster V, Harrington RA, Narula J, Eapen ZJ, editors. Hurst’s The Heart. 14th ed, Vol. One. USA: McGraw Hill; 995. Link: https://bit.ly/3grnUB9
Libby P, Hansson GK (2015) Inflammation and inflammatory diseases of the arterial tree: Players and layers. Circ Res 116: 307-311. Link: https://bit.ly/2WZhZey
Braunwald E (2012) The treatment of acute myocardial infarction: The Past, the Present, and the Future E ur Heart J Acute Cardiovasc Care 1: 9–12. Link: https://bit.ly/36AAn0M
Yusuf S, Rangarajan S, Teo K, Islam S, Li W, et al. (2014) Cardiovascular risk and events in 17 low-, middle-, and high-income countries. The New England Journal of Medicine 371: 818–827. Link: https://bit.ly/36v1A4T
Islam M, Bhattacharjee B, Chowdhury MAY, Siddique AN, Karim AMMR (2016) Outcome of Acute Myocardial Infarction Patients Admitted in a Tertiary Care Hospital. Medicine Today 28: 6-8. Link: https://bit.ly/36vnJQk
Puymirat E, Simon T, Cayla G, Cottin Y, Elbaz M, et al. (2017) Acute Myocardial Infarction: Changes in Patient Characteristics, Management, and 6-Month Outcomes Over a Period of 20 Years in the FAST-MI Program (French Registry of Acute ST-Elevation or Non-ST-Elevation Myocardial Infarction) 1995 to 2015. Circulation 136: 1908-1919. Link: https://bit.ly/2Xs8CDl
Iliesiu A, Campeanu A, Dusceac D (2010) Serum uric acid and cardiovascular disease. Maedica 5: 186-192. Link: https://bit.ly/3d37sVh
Car S, Trkulja V (2009) Higher Serum Uric Acid on Admission Is Associated with Higher Short-term Mortality and Poorer Long-term Survival After Myocardial Infarction: Retrospective Prognostic Study. Croat Med J 50: 559-566. Link: https://bit.ly/3d27tcg
von Lueder TG, Girerd N, Atar D, Agewall S, Lamiral Z, et al. (2015) 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. Eur J Heart Fail 17: 1144–1151. Link: https://bit.ly/2WXC19s
Hossain MD, Ferdousi S, Islam MS, Paul D, Sultana T, et al. (2016) Prognostic value of serum Uric Acid in-hospital Mortality and Morbidity in Patients with acute Myocardial Infarction. University Heart Journal 12: 8-11. Link: https://bit.ly/2TErf61
Brodov Y, Chouraqui P, Goldenberg I, Boyko V, Mandelzweig L, et al. (2009) Serum uric acid for risk stratification of patients with coronary artery disease. Cardiology 114: 300-305. Link: https://bit.ly/2yAqIL4
Maxwell AJ, Bruinsma KA (2011) Uric acid is closely linked to vascular nitric oxide activity: Evidence for mechanism of association with cardiovascular disease. J Am Coll Cardiol 38: 1850-1858. Link: https://bit.ly/3cZqHiM
Weir CJ, Muir SW, Walters MR, Lees KR (2003) Serum urate as an independent predictor of poor outcome and future vascular events after acute stroke. Stroke 34: 1951-1956. Link: https://bit.ly/2A9UxlP
Kojima S, Sakamoto T, Ishihara M, Kimura K, Miyazaki S, et al. (2005) Prognostic Usefulness of Serum Uric Acid After Acute Myocardial Infarction (The Japanese Acute Coronary Syndrome Study). Am J Cardiol 96: 489-495. Link: https://bit.ly/3go2d4D
Omidvar B, Ayatollahi F, Alasti M (2012) The prognostic role of serum uric acid level in patients with acute ST elevation myocardial infarction. J Saudi Heart Assoc 24: 73–78. Link: https://bit.ly/2Zxv68E
Belle L, Cayla G, Cottin Y, Coste P, Khalife K, et al. (2017) French Registry on Acute ST-elevation and non-ST-elevation Myocardial Infarction 2015 (FAST-MI 2015). Design and baseline data. Arch Cardiovasc Dis 110: 366-378. Link: https://bit.ly/2ZGEmqS
Safi AJ, Mahmood R, Khan A, Ul Haq A (2004) Association of serum uric acid with type 2 diabetes mellitus. Journal of Postgraduate Medical Institute 18: 59-63.
Das A, Dhandapani E, Sugumar A, Manam A (2015) Study of serum uric acid levels in acute myocardial infarction. International Journal of Pharma and Bio Sciences 6: 222-226.
Zahid MA, Khan HILR, Chowdhury AW, Sabah KMN, Kabir SMEZ, et al. (2015) Demographic Profile of NSTEMI (Non ST Elevation Myocardial Infarction) Patients & Association of ST-Segment Depression and Level of Troponin I with NSTEMI Patient's In-Hospital Outcome. Medicine Today 27:14-19.
Bickel C, Rupprecht HJ, Blankenberg S, Rippin G, Hafner G, et al. (2002) Serum Uric Acid as an Independent Predictor of Mortality in Patients With Angiographically Proven Coronary Artery Disease. Am J Cardiol 89: 12-17. Link: https://bit.ly/2TyN7PV
Biswas K, Halder S, Sarkar R, Roy K (2016) A study on prognostic significance of serum uric acid in acute myocardial infarction in a tertiary care institute. International Journal of Research in Medical Sciences 4: 4557-4562. Link: https://bit.ly/3gmXpwD
Lazzeri C, Valente S, Chiostri M, Sori A, Bernardo P, et al. (2010) Uric acid in the acute phase of ST elevation myocardial infarction submitted to primary PCI: Its prognostic role and relation with inflammatory markers: A single center experience. Int J Cardiol 138: 206–219. Link: https://bit.ly/2Xyxxp0
Ndrepepa G, Siegmund B, Hans-Ullrich H, Stefanie S, Sabine R, et al.( 2012) Prognostic Value of Uric Acid in Patients with Acute Coronary Syndromes. Am J Cardiol 109: 1260-1265. Link: https://bit.ly/2X1fk4o