Uric acid and risk of periprocedural myocardial infarction in patients undergoing percutaneous coronary intervention

Background: Periprocedural myocardial infarction still occurs in patients undergoing percutaneous coronary intervention. However, very little is known about the role of biomarkers possibly predicting this complication. Serum uric acid has been associated with enhanced inflammatory status, higher thrombotic risk and poorer outcome after percutaneous coronary intervention. We therefore, evaluated the association between uric acid levels and periprocedural myocardial infarction in patients undergoing percutaneous coronary intervention. Methods: We evaluated 1272 consecutive patients undergoing percutaneous coronary intervention. We measured myonecrosis biomarkers at intervals from 8 to 48h after percutaneous coronary intervention. Periprocedural myonecrosis was defined as a troponin I increase by 3 times the upper limit normal (ULN) or by 50% of an elevated baseline value and periprocedural myocardial infarction as creatine kinase-Myocardial Band increase by 3 times the ULN or 50% of baseline. Results: Patients were divided according to tertile values of uric acid (<5.40, ≥6.70mg/dL). Serum uric acid was related to age, male gender, hypertension, smoking, renal failure (p<0.001), previous coronary artery bypass grafts (p=0.05), therapy with ACE inhibitors (p=0.001) and diuretics (p<0.001), glycaemia (p=0.001), creatinine (p<0.001), haemoglobin (p=0.002) and white blood cells (p=0.02). Serum uric acid was inversely related to type C lesions (p=0.03) and coronary thrombus (p=0.02). SUA did not affect the risk of periprocedural myocardial infarction (p=0.29; adjusted odds ratio=1.11[0.93-1.32], p=0.26) or periprocedural myonecrosis (p=0.97; adjusted odds ratio=0.99[0.86-1.14], p=0.89). Results were confirmed at subgroup analyses of higher-risk subsets of patients. Conclusion: This is the first large study showing that serum uric acid is not associated with an increase in the risk of periprocedural myocardial infarction in patients undergoing percutaneous coronary revascularization.