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

Alessandro Mandurino-Mirizzi, Gabriele Crimi, Claudia Raineri, Silvia Pica, Marta Ruffinazzi, Umberto Gianni, Alessandra Repetto, Marco Ferlini, Barbara Marinoni, Sergio Leonardi, Stefano De Servi, Luigi Oltrona Visconti, Gaetano M De Ferrari, Maurizio Ferrario

Research output: Contribution to journalArticle

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 (42.3 ± 22 vs. 29.1 ± 15 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, all-cause 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 (Hagerstown, Md.)
Volume19
Issue number5
DOIs
Publication statusPublished - May 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

  • Aged
  • Angiography
  • Female
  • Humans
  • Kaplan-Meier Estimate
  • Linear Models
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Myocardial Reperfusion Injury/blood
  • Myocardium/pathology
  • Percutaneous Coronary Intervention
  • Risk Factors
  • ST Elevation Myocardial Infarction/blood
  • Treatment Outcome
  • Uric Acid/blood

Cite this

Elevated serum uric acid affects myocardial reperfusion and infarct size in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. / Mandurino-Mirizzi, Alessandro; Crimi, Gabriele; Raineri, Claudia; Pica, Silvia; Ruffinazzi, Marta; Gianni, Umberto; Repetto, Alessandra; Ferlini, Marco; Marinoni, Barbara; Leonardi, Sergio; De Servi, Stefano; Oltrona Visconti, Luigi; De Ferrari, Gaetano M; Ferrario, Maurizio.

In: Journal of cardiovascular medicine (Hagerstown, Md.), Vol. 19, No. 5, 05.2018, p. 240-246.

Research output: Contribution to journalArticle

Mandurino-Mirizzi, A, Crimi, G, Raineri, C, Pica, S, Ruffinazzi, M, Gianni, U, Repetto, A, Ferlini, M, Marinoni, B, Leonardi, S, De Servi, S, Oltrona Visconti, L, De Ferrari, GM & Ferrario, M 2018, 'Elevated serum uric acid affects myocardial reperfusion and infarct size in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention', Journal of cardiovascular medicine (Hagerstown, Md.), vol. 19, no. 5, pp. 240-246. https://doi.org/10.2459/JCM.0000000000000634
Mandurino-Mirizzi, Alessandro ; Crimi, Gabriele ; Raineri, Claudia ; Pica, Silvia ; Ruffinazzi, Marta ; Gianni, Umberto ; Repetto, Alessandra ; Ferlini, Marco ; Marinoni, Barbara ; Leonardi, Sergio ; De Servi, Stefano ; Oltrona Visconti, Luigi ; De Ferrari, Gaetano M ; Ferrario, Maurizio. / Elevated serum uric acid affects myocardial reperfusion and infarct size in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. In: Journal of cardiovascular medicine (Hagerstown, Md.). 2018 ; Vol. 19, No. 5. pp. 240-246.
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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 (42.3 ± 22 vs. 29.1 ± 15 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, all-cause 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.",
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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 {Oltrona Visconti}, Luigi and {De Ferrari}, {Gaetano M} and Maurizio Ferrario",
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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 - Oltrona Visconti, Luigi

AU - De Ferrari, Gaetano M

AU - Ferrario, Maurizio

PY - 2018/5

Y1 - 2018/5

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 (42.3 ± 22 vs. 29.1 ± 15 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, all-cause 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 (42.3 ± 22 vs. 29.1 ± 15 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, all-cause 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 - Aged

KW - Angiography

KW - Female

KW - Humans

KW - Kaplan-Meier Estimate

KW - Linear Models

KW - Magnetic Resonance Imaging

KW - Male

KW - Middle Aged

KW - Myocardial Reperfusion Injury/blood

KW - Myocardium/pathology

KW - Percutaneous Coronary Intervention

KW - Risk Factors

KW - ST Elevation Myocardial Infarction/blood

KW - Treatment Outcome

KW - Uric Acid/blood

U2 - 10.2459/JCM.0000000000000634

DO - 10.2459/JCM.0000000000000634

M3 - Article

VL - 19

SP - 240

EP - 246

JO - Journal of Cardiovascular Medicine

JF - Journal of Cardiovascular Medicine

SN - 1558-2027

IS - 5

ER -