Relationship between uric acid/ albumin ratio and coronary slow flow

Year 2023, Volume: 9 Issue: 5 - September 2023, 1171 - 1177, 04.09.2023

Aykut Demirkıran , Cihan Aydın

https://doi.org/10.18621/eurj.1340527

Abstract

Objectives: Although the pathophysiology of coronary slow flow is not fully understood, evidence suggesting endothelial dysfunction and subclinical widespread atherosclerosis in genesis has grown in recent years. Our aim in this study is to investigate the relationship between uric acid/ albumin ratio and coronary slow flow.

Methods: One hundred and five coronary slow flow patients (determined by the Thrombolysis in Myocardial Infarction-frame count method) and one-hundred patients with normal coronary low were included retrospectively. The uric acid/ albumin ratio was investigated in all patients participating.

Results: In the logistic regression analysis, it was revealed that high uric acid levels, uric acid/ albumin ratios, and male gender were independent predictors for coronary slow flow. Among these parameters, the uric acid/ albumin ratio was the best predictor of coronary slow flow. Based on the receiver operating characteristics (ROC) analysis, the cut-off value of uric acid/ albumin ratio ≥ 0.57 was found to predict coronary slow flow with 68.3% sensitivity and 68.7% specificity. In multivariate logistic regression analysis, high uric acid levels (OR: 2.22; 95% CI (1.551-3.200), p < 0.001), high serum uric acid/ albumin ratio (OR: 37.7 95% CI (8.176-234.387), p < 0.001), male gender (OR: 0.157; 95% CI (0.078-0.318), p < 0.001) were independent predictors of coronary slow flow.

Conclusions: High uric acid/ albumin ratio was detected as an independent predictor for coronary slow flow. Larger studies are needed to elucidate its role in the pathophysiology of coronary slow flow.

Keywords

Uric acid, uric acid/ albumin ratio, coronary slow flow

References

• 1. Tambe AA, Demany MA, Zimmerman HA, Mascarenhas E. Angina pectoris and slow flow velocity of dye in coronary arteries--a new angiographic finding. Am Heart J 1972;84:66-71.
• 2. Gibson CM, Cannon CP, Daley WL, Dodge JT Jr, Alexander B Jr, Marble SJ, et al. TIMI frame count: a quantitative method of assessing coronary artery flow. Circulation 1996;93:879-88.
• 3. Chalikias G, Tziakas D. Slow coronary flow: pathophysiology, clinical implications, and therapeutic management. Angiology 2021;72:808-18.
• 4. Karimi Y, Sehati F, Sarreshtedari A, Mirzad M, Khalili Y, Kiani R, et al. Endothelial nitric oxide synthase Asp298Glu (894G/T) gene polymorphism as a possible risk factor for the coronary slow flow phenomenon among Iranians. BMC Cardiovasc Disord 2022; 22:300.
• 5. Lopez-Sublet M, Girerd N, Bozec E, Machu JL, Ferreira JP, Zannad F, et al. Nondipping pattern and cardiovascular and renal damage in a population-based study (The STANISLAS Cohort Study). Am J Hypertens 2019;32:620-8.
• 6. Zhao L, Li Y, Yao D, Sun R, Liu S, Chen X, et al. Pharmacological basis for use of a novel compound in hyperuricemia: anti-hyperuricemic and anti-inflammatory effects. Front Pharmacol 2021;12:772504.
• 7. Han M, Kim H, Kim HJ, Kang E, Kim YS, Choi KH, et al. Serum uric acid is associated with coronary artery calcification in early chronic kidney disease: a cross-sectional study. BMC Nephrol 2021;22:247.
• 8. Saito Y, Nakayama T, Sugimoto K, Fujimoto Y, Kobayashi Y, et al. Relation of lipid content of coronary plaque to level of serum uric acid. Am J Cardiol 2015;116:1346-50.
• 9. Freilich M, Arredondo A, Zonnoor SL, McFarlane IM. Elevated serum uric acid and cardiovascular disease: a review and potential therapeutic interventions. Cureus 2022;14:e23582.
• 10. Jang S, Jeong M, Song J, Park K, Sim D, Kim J. Clinical impact of serum uric acid in patients with acute myocardial infarction. JACC 2014;63:A239.
• 11. Ndrepepa G, Braun S, Haase HU, Schulz S, Ranftl S, Hadamitzky M, et al. Prognostic value of uric acid in patients with acute coronary syndromes. Am. J. Cardiol 2012;109:1260-5.
• 12. Kai T, Oka S, Hoshino K, Watanabe K, Nakamura J, Abe M, et al. Renal dysfunction as a predictor of slow-flow/no-reflow phenomenon and impaired ST segment resolution after percutaneous coronary intervention in ST-elevation myocardial infarction with initial Thrombolysis in Myocardial Infarction grade 0. Circ J 2021;85:1770-8.
• 13. Ndrepepa G. Uric acid and cardiovascular disease. Clin Chim Acta 2018; 484:150-63.
• 14. Glantzounis GK, Tsimoyiannis EC, Kappas AM, Galaris DA. Uric acid and oxidative stress. Curr Pharm Des 2005;11:4145-51.
• 15. Saag KG, Becker MA, White WB, Whelton A, Borer JS, Gorelick PB, et al. Evaluation of the relationship between serum urate levels, clinical manifestations of gout, and death from cardiovascular causes in patients receiving febuxostat or allopurinol in an outcomes trial. Arthritis Rheumatol 2022;74:1593-601.
• 16. Holme I, Aastveit AH, Hammar N, Jungner I, Walldius G. Uric acid and risk of myocardial infarction, stroke and congestive heart failure in 417,734 men and women in the apolipoprotein MOrtality RISk study (AMORIS). J Intern Med 2009;266:558-70.
• 17. Fang J, Alderman MH. Serum uric acid and cardiovascular mortality the NHANES I epidemiologic follow-up study, 1971-1992. National Health and nutrition examination survey. JAMA 2000;283:2404-10.
• 18. Ma M, Wang L, Zhong X, Zhong L, Chen R, Li L, et al. Age and gender differences between carotid intima-media thickness and serum uric acid. Am J Cardiol 2022;172:137-43.
• 19. Gagliardi AC, Miname MH, Santos RD. Uric acid: a marker of increased cardiovascular risk. Atherosclerosis 2009;202:11-7.
• 20. Johnson RJ, Rodriguez-Iturbe B, Kang DH, Feig DI, Herrera-Acosta J. A unifying pathway for essential hypertension. Am J Hypertens 2005;18:431-40.
• 21. He Y, Wang D, Zhou X, Zhu Q, Lin Q, Hong X, et al. Interaction between hyperuricemia and admission lactate increases the risk of acute kidney injury in patients with ST-segment elevation myocardial infarction. Cardiorenal Med 2022;12:189-95.
• 22. Chang HY, Lee PH, Lei CC, Tung CW, Hsu YC, Huang TJ, et al. Hyperuricemia is an independent risk factor for new onset micro-albuminuria in a middle-aged and elderly population: a prospective cohort study in taiwan. PloS One 2013;8:e61450.
• 23. Saya S, Hennebry TA, Lozano P, Lazzara R, Schechter E. Coronary slow flow phenomenon and risk for sudden cardiac death due to ventricular arrhythmias: a case report and review of literature. Clin Cardiol 2008;31:352-5.
• 24. Wang X, Nie SP. The coronary slow flow phenomenon: characteristics, mechanisms and implications. Cardiovasc Diagn Ther 2011;1:37-43.