Thomas G von Lueder1,2, Nicolas Girerd3,4,5,6, Dan Atar1,2, Stefan Agewall1,2, Zohra Lamiral3,4,5,6, Mehmet Kanbay7, Bertram Pitt8, Kenneth Dickstein9, Faiez Zannad3,4,5,6, Patrick Rossignol3,4,5,6. 1. Department of Cardiology B, Division of Medicine, Oslo University Hospital Ullevål, University of Oslo, Norway. 2. Center for Heart Failure Research, University of Oslo, Norway. 3. INSERM, Centre d'Investigations Cliniques-1433, and INSERM U1116, Nancy, France. 4. CHU Nancy, Institut Lorrain du Cœur et des Vaisseaux, Vandoeuvre lès Nancy, France. 5. Université de Lorraine, Nancy, France. 6. F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists) Network, Nancy, France. 7. Department of Medicine, Division of Nephrology, Koc University School of Medicine, Istanbul, Turkey. 8. University of Michigan School of Medicine, Ann Arbor, MI, USA. 9. Division of Cardiology, University of Bergen, Stavanger University Hospital, Stavanger, Norway.
Abstract
AIMS: 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. METHODS AND 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.
RCT Entities:
AIMS: 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. METHODS AND 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: Baris Afsar; Alan A Sag; Cinar Oztosun; Masanari Kuwabara; Mario Cozzolino; Adrian Covic; Mehmet Kanbay Journal: J Nephrol Date: 2019-04-27 Impact factor: 3.902
Authors: Susan Stienen; João Pedro Ferreira; Nicolas Girerd; Kévin Duarte; Zohra Lamiral; John J V McMurray; Bertram Pitt; Kenneth Dickstein; Faiez Zannad; Patrick Rossignol Journal: Clin Res Cardiol Date: 2019-04-05 Impact factor: 5.460
Authors: João Pedro Ferreira; Nicolas Girerd; Pierpaolo Pellicori; Kevin Duarte; Sophie Girerd; Marc A Pfeffer; John J V McMurray; Bertram Pitt; Kenneth Dickstein; Lotte Jacobs; Jan A Staessen; Javed Butler; Roberto Latini; Serge Masson; Alexandre Mebazaa; Hans Peter Brunner-La Rocca; Christian Delles; Stephane Heymans; Naveed Sattar; J Wouter Jukema; John G Cleland; Faiez Zannad; Patrick Rossignol Journal: BMC Med Date: 2016-11-10 Impact factor: 8.775