Survival prediction role of serum uric acid in patients with acute myocardial infarction accompanying heart failure with preserved ejection fraction

Soohyun Kim¹Kwan Yong Lee^2*Kyung An Kim¹Jaeho Byeon¹Sanghoon Shin²Byung-Hee Hwang²Jin Jin Kim²Eun Ho Choo²Chan Joon Kim³Young Kyoung Sa⁴Mahn-Won Park⁵Sangho Hyun⁶Andrew H Yoon⁷Youngkeun Ahn⁸Kiyuk Chang²

• ¹Cardiovascular Center and Cardiology Division, Incheon St. Mary’s Hospital, The Catholic University of Korea, Seoul, Republic of Korea, Incheon, Republic of Korea
• ²Department of Cardiology, Seoul St. Mary's Hospital, Seoul, Republic of Korea
• ³Division of Cardiology, Department of Internal Medicine, Uijeonbu St.Mary's Hospital, Uijeongbu, Republic of Korea
• ⁴Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
• ⁵Division of Cardiology, Department of Internal Medicine, Daejeon St.Mary's Hospital, Daejeon, Republic of Korea
• ⁶College of Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
• ⁷Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
• ⁸Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwangju, Republic of Korea

Background: Heart failure with preserved ejection fraction (HFpEF) is defined as presenting clinical symptoms and signs of heart failure with concomitant left ventricular ejection fraction ≥ 50%. However, serum uric acid as prognostic role in HFpEF is not well recognized. Methods: Total 757 HFpEF patients with acute myocardial infarction were included for analysis. Hyperuricemia was defined by serum uric acid level > 6.9 mg/dL in male, > 5.4mg/dL in female at the time of diagnosis of acute myocardial infarction. The primary outcome was all cause mortality. Results: Among enrolled patients, 164 and 593 were divided into high uric acid and normal uric acid group respectively. During median follow up of 4.8 [interquartile range 3.2; 7.1] years, 54 (32.9%) in high serum uric acid group and 92 (15.5%) in normal serum uric acid group had died. Hyperuricemia was independently associated with all-cause mortality (p<0.001) and cardiovascular death (73[12.3%] vs 44[26.8%], p<0.001). The increased risk of mortality remained consistent in the multivariate Cox proportional hazards model (Hazard ratio 1.5, 95% Confidence Interval 1.03-2.19, p=0.033). After classifying the enrolled patients with Heart Failure Association – Pre-test assessment, Echocardiography & natriuretic peptide, Functional testing, and Final etiological work-up (HFA-PEFF) score (366 in HFA-PEFF score < 3, 391 in HFA-PEFF score ≥ 3 points), hyperuricemia was also associated with all-cause mortality in patients with more than intermediate scores (≥ 3 points), (p < 0.001). Conclusions: In acute myocardial infarction cohort, hyperuricemia was independently associated with all-cause mortality in HFpEF patients. Trial registration : The COREA-AMI registry is registered on ClinicalTrials.gov (study ID: NCT02806102).