Uric acid for diagnosis and risk stratification in suspected myocardial infarction
| Autor: | Christian Mueller, Karin Wildi, Philip Haaf, Resat Acemoglu, Beatrice Drexler, Susanne Ernst, Raphael Twerenbold, Tobias Reichlin, Christa Zellweger, Jeannine Schneider, Mira Mueller, Cathrin Balmelli, Heike Freidank, Miriam Reiter, Tamina Mosimann, Carles Vilaplana, Paola Ballarino, Berit Moehring |
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| Rok vydání: | 2012 |
| Předmět: |
Male
medicine.medical_specialty Acute coronary syndrome Clinical Biochemistry Myocardial Infarction 030204 cardiovascular system & hematology Chest pain Biochemistry 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Troponin complex Predictive Value of Tests Risk Factors Internal medicine medicine Humans 030212 general & internal medicine Myocardial infarction Intensive care medicine Aged Framingham Risk Score business.industry General Medicine Middle Aged medicine.disease Uric Acid 3. Good health Oxidative Stress Early Diagnosis chemistry Cardiology Uric acid Female Myocardial infarction diagnosis medicine.symptom business Biomarkers TIMI |
| Zdroj: | European journal of clinical investigation European Journal of Clinical Investigation |
| ISSN: | 0014-2972 |
| DOI: | 10.1111/eci.12029 |
| Popis: | Background: Hypoxia precedes cardiomyocyte necrosis in acute myocardial infarction (AMI). We therefore hypothesized that uric acid as a marker of oxidative stress and hypoxia might be useful in the early diagnosis and risk stratification of patients with suspected AMI. Materials and methods: In this prospective observational study uric acid was measured at presentation in 892 consecutive patients presenting to the emergency department with suspected AMI. The final diagnosis was adjudicated by two independent cardiologists. Patients were followed 24 months regarding mortality. Primary outcome was the diagnosis of AMI secondary outcome was short and long term mortality. Results: Uric acid at presentation was higher in patients with AMI than in patients without (372 µM vs. 336 µM; P < 0·001). The diagnostic accuracy of uric acid for AMI as quantified by the area under the receiver operating characteristic curve (AUC) was 0·60 (95Cl 0·56 0·65). When added to cardiac troponin T (cTnT) uric acid significantly increased the AUC of cTnT from 0·89 (95Cl 0·85 0·93) to 0·92 (95Cl 0·89 0·95 P = 0·020 for comparison). Cumulative 24 month mortality rates were 2·2 in the first 5·4 in the second and the third and 15·6 in the fourth quartile of uric acid (P < 0·001 for log rank). Uric acid predicted 24 month mortality independently. Adding uric acid to TIMI and GRACE risk score improved their prognostic accuracy as shown by an integrated discrimination improvement of 0·04 (P = 0·007) respective 0·02 (P = 0·021). Conclusions: Uric acid an inexpensive widely available biomarker improves both the early diagnosis and risk stratification of patients with suspected AMI. © 2012 Stichting European Society for Clinical Investigation Journal Foundation. |
| Databáze: | OpenAIRE |
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