Association Between Serum Uric Acid and Perioperative and Late Cardiovascular Outcome in Patients With Suspected or Definite Coronary Artery Disease Undergoing Elective Vascular Surgery

• Published in: The American journal of cardiology Vol. 102; no. 7; pp. 797 - 801
• Main Authors: Dunkelgrun, Martin, MD, Welten, Gijs M.J.M., MD, Goei, Dustin, MD, Winkel, Tamara A., MD, Schouten, Olaf, MD, van Domburg, Ron T., PhD, van Gestel, Yvette R.B.M., MSc, Flu, Willem-Jan, MD, Hoeks, Sanne E., MSc, Bax, Jeroen J., MD, Poldermans, Don, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.10.2008; Elsevier; Elsevier Limited
• Subjects: Acids; Aged; Biological and medical sciences; Biomarkers - blood; Cardiology; Cardiology. Vascular system; Cardiovascular; Cardiovascular disease; Coronary Artery Disease - blood; Coronary Artery Disease - mortality; Coronary heart disease; Elective Surgical Procedures - mortality; Female; Heart; Heart surgery; Humans; Logistic Models; Male; Medical sciences; Mortality; Multivariate analysis; Proportional Hazards Models; Regression analysis; Retrospective Studies; Risk Assessment; Risk factors; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Treatment Outcome; Uric Acid - blood; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels; Vascular Surgical Procedures - mortality; Human; Late; Vascular surgery; Prognosis; Cardiovascular disease; Uric acid; Coronary heart disease; Perioperative; Association; Evolution; Serum; Circulatory system; Cardiology; Elective
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2008.05.019

The role of uric acid as an independent marker of cardiovascular risk is unclear. Therefore, our aim was to assess the independent contribution of preoperative serum uric acid levels to the risk of 30-day and late mortality and major adverse cardiac event (MACE) in patients scheduled for open vascular surgery. In total, 936 patients (76% male, age 68 ± 11 years) were enrolled. Hyperuricemia was defined as serum uric acid >0.42 mmol/l for men and >0.36 mmol/l for women, as defined by large epidemiological studies. Outcome measures were 30-day and late mortality and MACE (cardiac death or myocardial infarction). Multivariable logistic and Cox regression analysis were used, adjusting for age, gender, and all cardiac risk factors. Data are presented as odds ratios or hazard ratios, with 95% confidence intervals. Hyperuricemia was present in 299 patients (32%). The presence of hyperuricemia was associated with heart failure, chronic kidney disease, and the use of diuretics. Perioperatively, 46 patients (5%) died and 61 patients (7%) experienced a MACE. Mean follow-up was 3.7 years (range: 0 to 17 years). During follow-up, 282 patients (30%) died and 170 patients (18%) experienced a MACE. After adjustment for all clinical risk factors, the presence of hyperuricemia was not significantly associated with an increased risk of 30-day mortality or MACE, odds ratios of 1.5 (0.8 to 2.8) and 1.7 (0.9 to 3.0), respectively. However, the presence of hyperuricemia was associated with an increased risk of late mortality and MACE, with hazard ratios of 1.4 (1.1 to 1.7) and 1.7 (1.3 to 2.3), respectively. In conclusion, the presence of preoperative hyperuricemia in vascular patients is a significant predictor of late mortality and MACE.