Association of serum uric acid/albumin ratio with completely occluded infarct-related artery in patients with non-ST-segment elevation myocardial infarction

Year 2023, , 21 - 27, 10.02.2023

Orhan Karayiğit

https://doi.org/10.47582/jompac.1217035

Abstract

Aim: Infarct-related artery (IRA) patency before primary percutaneous coronary intervention (pPCI) is linked to improved clinical outcomes and lower mortality in patients with acute coronary syndrome. The purpose of this research was to examine the association between serum uric acid/albumin ratio (UAR) and IRA patency in patients with non-ST-segment elevation myocardial infarction (NSTEMI).
Material and Method: We evaluated 430 consecutive patients with NSTEMI in total retrospectively. The study population was divided into 2 groups according to the IRA patency as assessed by the degree of Thrombolysis in Myocardial Infarction (TIMI) flow before pPCI. As a result, completely occluded IRA was defined as TIMI grade 0-1, while patent IRA was defined as TIMI grade 2-3.
Results: IRA was found to be occluded in 110 (25.5%) patients prior to the procedure. UAR level (p=<0.001) was found to be higher among the patients with IRA occlusion when compared to the patent group. Regression analysis revealed that UAR (OR:3.125; 95% CI:1.186-8.232, p<0.001), left ventricular ejection fraction (OR:0.917, 95% CI:0.885-0.951, p<0.001) and culprit artery diameter (OR:0.917, 95% CI:0.885-0.951, p<0.001) were independent predictors for an occluded IRA. An UAR cut-off value of >1.40 was detected to prognosticate the occluded IRA with 62.7% sensitivity and 63.8% specificity (AUC: 0.722, 95% CI: 0.671-0.773, p<0.001).
Conclusion: UAR is an independent predictor of preprocedural IRA patency in patients with NSTEMI. Thus, UAR may be an easily accessible parameter to diagnose high-risk NSTEMI patients who would benefit from an immediate invasive strategy (<2 hours).

Keywords

Serum uric acid/albumin ratio, infarct-related artery, non-ST elevation myocardial infarction

ST-segment yükselmesiz miyokard enfarktüslü hastalarda serum ürik asit/albümin oranı ile tamamen tıkalı enfarkt ilişkili arter arasındaki ilişki

Abstract

Amaç: Akut koroner sendromlu hastalarda, primer perkütan koroner girişim (PKG) öncesi enfarkt ilişkili arter (EİA) açıklığı, daha iyi klinik sonlanımlar ve düşük mortalite ile ilişkilidir. Bu çalışmada, ST-segment yükselmesiz miyokard enfarktüslü (NSTEMI) hastalarda serum ürik asit/albümin oranı (UAR) ve EİA açıklığı arasındaki ilişkiyi araştırmayı amaçladık.
Gereç ve Yöntem: Toplam 430 ardışık NSTEMI hastası geriye dönük olarak değerlendirildi. Çalışma popülasyonu, PKG öncesi Miyokard Enfarktüsünde Tromboliz (TIMI) akış derecesi ile değerlendirilen EİA açıklığına göre 2 gruba ayrıldı. Tamamen tıkalı EİA TIMI derece 0/1 olarak tanımlandı ve patent EİA TIMI 2/3 olarak tanımlandı.
Bulgular: İşlem öncesi 110 (%25.5) hastada EİA tıkalı olarak bulundu. EİA tıkalı olan grupta, patent olan gruba göre UAR düzeyi (p=<0.001) daha yüksek saptandı. Regresyon analizi UAR (OR:3.125, %95 GA:1.186-8.232; p<0.001), sol ventrikül ejeksiyon fraksiyonu (OR:0.917, %95 GA:0.885-0.951; p<0.001) ve sorumlu arter çapının (OR:0.917, %95 GA:0.885-0.951; p<0.001) tıkalı bir EİA için bağımsız öngördürücüleri olduğunu ortaya koydu. >1.40’lık bir UAR eşik değerinin, %62.7 duyarlılık ve %63.8 özgüllük ile tıkalı bir EİA’yı öngördüğü bulundu (AUC: 0.722, %95 GA: 0.671-0.773; p<0.001).
Sonuç: UAR, NSTEMI’li hastalarda işlem öncesi EİA açıklığının bağımsız bir öngördürücüsüdür. Böylece, UAR acil invaziv stratejiden (<2 saat) fayda görecek yüksek riskli NSTEMI hastalarını belirlemede kolay erişilebilir bir parametre olabilir.

Keywords

serum ürik asit/albümin oranı, ST yükselmesiz miyokard enfarktüsü, enfarkt ilişkili arter

References

• Stone GW, Cox D, Garcia E, et al. Normal flow (TIMI-3) before mechanical reperfusion therapy is an independent determinant of survival in acute myocardial infarction: analysis from the primary angioplasty in myocardial infarction trials. Circulation 2001; 104: 636-41.
• Neumann FJ, Sousa-Uva M, Ahlsson A, et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J 2019; 40: 87–165.
• Collet JP, Thiele H, Barbato E, et al. ESC Scientific Document Group. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J 2021; 42: 1289-367.
• Chan MY, Sun JL, Newby LK, et al. Long-term mortality of patients undergoing cardiac catheterization for ST-elevation and non‑ST‑elevation myocardial infarction. Circulation 2009; 119: 3110‑7.
• Hung CS, Chen YH, Huang CC, et al. Prevalence and outcome of patients with non-ST segment elevation myocardial infarction with occluded "culprit" artery - a systemic review and meta-analysis. Crit Care 2018; 22: 34.
• Khan AR, Golwala H, Tripathi A, et al. Impact of total occlusion of culprit artery in acute non-ST elevation myocardial infarction: a systematic review and meta-analysis. Eur Heart J 2017; 38: 3082-9.
• Varma R, Michos GA, Varma RS, Brown RD Jr. The protein-bound carbohydrates of seromucoid from normal human serum. J Clin Chem Clin Biochem 1983; 21: 273-7.
• Arques S. Human serum albumin in cardiovascular diseases. Eur J Intern Med 2018;52:8-12.
• Li X, Meng X, Timofeeva M, et al. Serum uric acid levels and multiple health outcomes: umbrella review of evidence from observational studies, randomised controlled trials, and Mendelian randomisation studies. BMJ 2017; 357: j2376.
• Kanellis J, Kang DH. Uric acid as a mediator of endothelial dysfunction, inflammation, and vascular disease. Semin Nephrol 2005; 25: 39-42.
• Li S, Chen H, Zhou L, Cui H, Liang S, Li H. The uric acid to albumin ratio: a novel predictor of long-term cardiac mortality in patients with unstable angina pectoris after percutaneous coronary intervention. Scand J Clin Lab Invest 2022; 82: 304-10.
• Kalkan S, Cagan Efe S, Karagöz A, et al. A new predictor of mortality in ST-elevation myocardial ınfarction: the uric acid albumin ratio. Angiology 2022; 73: 461-9.
• The Thrombolysis in Myocardial Infarction (TIMI) trial. Phase I findings. TIMI Study Group. N Engl J Med 1985; 312: 932-6.
• Hashimoto T, Ako J, Nakao K, et al. J-MINUET investigators. Pre-procedural thrombolysis in myocardial ınfarction flow in patients with st-segment elevation myocardial infarction. Int Heart J 2018; 59: 920-5.
• Hwang HJ, Park CB, Cho JM, et al. Clinical characteristics of occluded culprit arteries and collaterals in patients with non-ST-segment elevation myocardial infarction and impact on clinical outcomes. Exp Ther Med 2018; 16: 3710-20.
• Kurtul A, Murat SN, Yarlioglues M, et al. Usefulness of serum albumin concentration to predict high coronary SYNTAX score and in-hospital mortality in patients with acute coronary syndrome. Angiology 2016; 67: 34-40.
• Celik IE, Yarlioglues M, Kurtul A, et al. Preprocedural albumin levels and risk of in-stent restenosis after coronary stenting with bare-metal stent. Angiology 2016; 67: 478-83.
• Suzuki S, Hashizume N, Kanzaki Y, Maruyama T, Kozuka A, Yahikozawa K. Prognostic significance of serum albumin in patients with stable coronary artery disease treated by percutaneous coronary intervention. PLoS One 2019; 14: e0219044.
• Halliwell B. Albumin–an important extracellular antioxidant? Biochem Pharmacol 1988; 37: 569-71.
• Jin M, Yang F, Yang I, et al. Uric acid, hyperuricemia and vascular diseases. Front Biosci 2012; 17: 656-69.
• Kanbay M, Segal M, Afsar B, Kang DH, Rodriguez-Iturbe B, Johnson RJ. The role of uric acid in the pathogenesis of human cardiovascular disease. Heart 2013; 99: 759.
• Çakmak EÖ, Bayam E, Çelik M, et al. Uric acid-to albumin ratio: a novel marker for the extent of coronary artery disease in patients with Non-ST-Elevated myocardial infarction. Pulse (Basel) 2021; 8: 99-107.
• Şaylık F, Çınar T, Akbulut T, Selçuk M. Serum uric acid to albumin ratio can predict contrast-ınduced nephropathy in ST-elevation myocardial ınfarction patients undergoing primary percutaneous coronary intervention. Angiology 2022: 33197221091605.