Elevated serum uric acid affects myocardial reperfusion and infarct size in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

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Abstract

Aims Elevated serum uric acid (eSUA) was associated with unfavorable outcome in patients with ST-segment elevation myocardial infarction (STEMI). However, the effect of eSUA on myocardial reperfusion injury and infarct size has been poorly investigated. Our aim was to correlate eSUA with infarct size, infarct size shrinkage, myocardial reperfusion grade and long-term mortality in STEMI patients undergoing primary percutaneous coronary intervention. Methods We performed a post-hoc patients-level analysis of two randomized controlled trials, testing strategies for myocardial ischemia/reperfusion injury protection. Each patient underwent acute (3-5 days) and follow-up (4-6 months) cardiac magnetic resonance. Infarct size and infarct size shrinkage were outcomes of interest. We assessed T2-weighted edema, myocardial blush grade (MBG), corrected Thrombolysis in myocardial infarction Frame Count, ST-segment resolution and long-term all-cause mortality. Results A total of 101 (86.1% anterior) STEMI patients were included; eSUA was found in 16 (15.8%) patients. Infarct size was larger in eSUA compared with non-eSUA patients (42.3W22 vs. 29.1W15 ml, P=0.008). After adjusting for covariates, infarct size was 10.3 ml (95% confidence interval 1.2-19.3 ml, P=0.001) larger in eSUA. Among patients with anterior myocardial infarction the difference in delayed enhancement between groups was maintained (respectively, 42.3±22.4 vs. 29.9±15.4 ml, P=0.015). Infarct size shrinkage was similar between the groups. Compared with non-eSUA, eSUA patients had larger T2- weighted edema (53.8 vs. 41.2 ml, P=0.031) and less favorable MBG (MBG<2: 44.4 vs. 13.6%, P=0.045). Corrected Thrombolysis in myocardial infarction Frame Count and ST-segment resolution did not significantly differ between the groups. At a median follow-up of 7.3 years, allcause mortality was higher in the eSUA group (18.8 vs. 2.4%, P=0.028). Conclusion eSUA may affect myocardial reperfusion in patients with STEMI undergoing percutaneous coronary intervention and is associated with larger infarct size and higher long-term mortality.

Original languageEnglish
Pages (from-to)240-246
Number of pages7
JournalJournal of Cardiovascular Medicine
Volume19
Issue number5
DOIs
Publication statusPublished - May 1 2018

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Myocardial Reperfusion
Percutaneous Coronary Intervention
Uric Acid
Myocardial Infarction
Serum
Myocardial Reperfusion Injury
Mortality
Edema
ST Elevation Myocardial Infarction
Reperfusion Injury
Myocardial Ischemia
Magnetic Resonance Spectroscopy
Randomized Controlled Trials
Confidence Intervals

Keywords

  • Infarct size
  • Percutaneous coronary intervention
  • ST-segment elevation myocardial infarction
  • Uric acid

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

@article{da8b0455d23142f5a42a1ffadfb76b85,
title = "Elevated serum uric acid affects myocardial reperfusion and infarct size in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention",
abstract = "Aims Elevated serum uric acid (eSUA) was associated with unfavorable outcome in patients with ST-segment elevation myocardial infarction (STEMI). However, the effect of eSUA on myocardial reperfusion injury and infarct size has been poorly investigated. Our aim was to correlate eSUA with infarct size, infarct size shrinkage, myocardial reperfusion grade and long-term mortality in STEMI patients undergoing primary percutaneous coronary intervention. Methods We performed a post-hoc patients-level analysis of two randomized controlled trials, testing strategies for myocardial ischemia/reperfusion injury protection. Each patient underwent acute (3-5 days) and follow-up (4-6 months) cardiac magnetic resonance. Infarct size and infarct size shrinkage were outcomes of interest. We assessed T2-weighted edema, myocardial blush grade (MBG), corrected Thrombolysis in myocardial infarction Frame Count, ST-segment resolution and long-term all-cause mortality. Results A total of 101 (86.1{\%} anterior) STEMI patients were included; eSUA was found in 16 (15.8{\%}) patients. Infarct size was larger in eSUA compared with non-eSUA patients (42.3W22 vs. 29.1W15 ml, P=0.008). After adjusting for covariates, infarct size was 10.3 ml (95{\%} confidence interval 1.2-19.3 ml, P=0.001) larger in eSUA. Among patients with anterior myocardial infarction the difference in delayed enhancement between groups was maintained (respectively, 42.3±22.4 vs. 29.9±15.4 ml, P=0.015). Infarct size shrinkage was similar between the groups. Compared with non-eSUA, eSUA patients had larger T2- weighted edema (53.8 vs. 41.2 ml, P=0.031) and less favorable MBG (MBG<2: 44.4 vs. 13.6{\%}, P=0.045). Corrected Thrombolysis in myocardial infarction Frame Count and ST-segment resolution did not significantly differ between the groups. At a median follow-up of 7.3 years, allcause mortality was higher in the eSUA group (18.8 vs. 2.4{\%}, P=0.028). Conclusion eSUA may affect myocardial reperfusion in patients with STEMI undergoing percutaneous coronary intervention and is associated with larger infarct size and higher long-term mortality.",
keywords = "Infarct size, Percutaneous coronary intervention, ST-segment elevation myocardial infarction, Uric acid",
author = "Alessandro Mandurino-Mirizzi and Gabriele Crimi and Claudia Raineri and Silvia Pica and Marta Ruffinazzi and Umberto Gianni and Alessandra Repetto and Marco Ferlini and Barbara Marinoni and Sergio Leonardi and {De Servi}, Stefano and Visconti, {Luigi Oltrona} and {De Ferrari}, {Gaetano M.} and Maurizio Ferrario",
year = "2018",
month = "5",
day = "1",
doi = "10.2459/JCM.0000000000000634",
language = "English",
volume = "19",
pages = "240--246",
journal = "Journal of Cardiovascular Medicine",
issn = "1558-2027",
publisher = "Lippincott Williams and Wilkins",
number = "5",

}

TY - JOUR

T1 - Elevated serum uric acid affects myocardial reperfusion and infarct size in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

AU - Mandurino-Mirizzi, Alessandro

AU - Crimi, Gabriele

AU - Raineri, Claudia

AU - Pica, Silvia

AU - Ruffinazzi, Marta

AU - Gianni, Umberto

AU - Repetto, Alessandra

AU - Ferlini, Marco

AU - Marinoni, Barbara

AU - Leonardi, Sergio

AU - De Servi, Stefano

AU - Visconti, Luigi Oltrona

AU - De Ferrari, Gaetano M.

AU - Ferrario, Maurizio

PY - 2018/5/1

Y1 - 2018/5/1

N2 - Aims Elevated serum uric acid (eSUA) was associated with unfavorable outcome in patients with ST-segment elevation myocardial infarction (STEMI). However, the effect of eSUA on myocardial reperfusion injury and infarct size has been poorly investigated. Our aim was to correlate eSUA with infarct size, infarct size shrinkage, myocardial reperfusion grade and long-term mortality in STEMI patients undergoing primary percutaneous coronary intervention. Methods We performed a post-hoc patients-level analysis of two randomized controlled trials, testing strategies for myocardial ischemia/reperfusion injury protection. Each patient underwent acute (3-5 days) and follow-up (4-6 months) cardiac magnetic resonance. Infarct size and infarct size shrinkage were outcomes of interest. We assessed T2-weighted edema, myocardial blush grade (MBG), corrected Thrombolysis in myocardial infarction Frame Count, ST-segment resolution and long-term all-cause mortality. Results A total of 101 (86.1% anterior) STEMI patients were included; eSUA was found in 16 (15.8%) patients. Infarct size was larger in eSUA compared with non-eSUA patients (42.3W22 vs. 29.1W15 ml, P=0.008). After adjusting for covariates, infarct size was 10.3 ml (95% confidence interval 1.2-19.3 ml, P=0.001) larger in eSUA. Among patients with anterior myocardial infarction the difference in delayed enhancement between groups was maintained (respectively, 42.3±22.4 vs. 29.9±15.4 ml, P=0.015). Infarct size shrinkage was similar between the groups. Compared with non-eSUA, eSUA patients had larger T2- weighted edema (53.8 vs. 41.2 ml, P=0.031) and less favorable MBG (MBG<2: 44.4 vs. 13.6%, P=0.045). Corrected Thrombolysis in myocardial infarction Frame Count and ST-segment resolution did not significantly differ between the groups. At a median follow-up of 7.3 years, allcause mortality was higher in the eSUA group (18.8 vs. 2.4%, P=0.028). Conclusion eSUA may affect myocardial reperfusion in patients with STEMI undergoing percutaneous coronary intervention and is associated with larger infarct size and higher long-term mortality.

AB - Aims Elevated serum uric acid (eSUA) was associated with unfavorable outcome in patients with ST-segment elevation myocardial infarction (STEMI). However, the effect of eSUA on myocardial reperfusion injury and infarct size has been poorly investigated. Our aim was to correlate eSUA with infarct size, infarct size shrinkage, myocardial reperfusion grade and long-term mortality in STEMI patients undergoing primary percutaneous coronary intervention. Methods We performed a post-hoc patients-level analysis of two randomized controlled trials, testing strategies for myocardial ischemia/reperfusion injury protection. Each patient underwent acute (3-5 days) and follow-up (4-6 months) cardiac magnetic resonance. Infarct size and infarct size shrinkage were outcomes of interest. We assessed T2-weighted edema, myocardial blush grade (MBG), corrected Thrombolysis in myocardial infarction Frame Count, ST-segment resolution and long-term all-cause mortality. Results A total of 101 (86.1% anterior) STEMI patients were included; eSUA was found in 16 (15.8%) patients. Infarct size was larger in eSUA compared with non-eSUA patients (42.3W22 vs. 29.1W15 ml, P=0.008). After adjusting for covariates, infarct size was 10.3 ml (95% confidence interval 1.2-19.3 ml, P=0.001) larger in eSUA. Among patients with anterior myocardial infarction the difference in delayed enhancement between groups was maintained (respectively, 42.3±22.4 vs. 29.9±15.4 ml, P=0.015). Infarct size shrinkage was similar between the groups. Compared with non-eSUA, eSUA patients had larger T2- weighted edema (53.8 vs. 41.2 ml, P=0.031) and less favorable MBG (MBG<2: 44.4 vs. 13.6%, P=0.045). Corrected Thrombolysis in myocardial infarction Frame Count and ST-segment resolution did not significantly differ between the groups. At a median follow-up of 7.3 years, allcause mortality was higher in the eSUA group (18.8 vs. 2.4%, P=0.028). Conclusion eSUA may affect myocardial reperfusion in patients with STEMI undergoing percutaneous coronary intervention and is associated with larger infarct size and higher long-term mortality.

KW - Infarct size

KW - Percutaneous coronary intervention

KW - ST-segment elevation myocardial infarction

KW - Uric acid

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U2 - 10.2459/JCM.0000000000000634

DO - 10.2459/JCM.0000000000000634

M3 - Article

AN - SCOPUS:85045181186

VL - 19

SP - 240

EP - 246

JO - Journal of Cardiovascular Medicine

JF - Journal of Cardiovascular Medicine

SN - 1558-2027

IS - 5

ER -