Uric acid for diagnosis and risk stratification in suspected myocardial infarction
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Uric acid for diagnosis and risk stratification in suspected myocardial infarction. / Wildi, Karin; Haaf, Philip; Reichlin, Tobias; Acemoglu, Resat; Schneider, Jeannine; Balmelli, Cathrin; Drexler, Beatrice; Twerenbold, Raphael; Mosimann, Tamina; Reiter, Miriam; Mueller, Mira; Ernst, Susanne; Ballarino, Paola; Zellweger, Christa; Moehring, Berit; Vilaplana, Carles; Freidank, Heike; Mueller, Christian.
In: EUR J CLIN INVEST, Vol. 43, No. 2, 02.2013, p. 174-182.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Uric acid for diagnosis and risk stratification in suspected myocardial infarction
AU - Wildi, Karin
AU - Haaf, Philip
AU - Reichlin, Tobias
AU - Acemoglu, Resat
AU - Schneider, Jeannine
AU - Balmelli, Cathrin
AU - Drexler, Beatrice
AU - Twerenbold, Raphael
AU - Mosimann, Tamina
AU - Reiter, Miriam
AU - Mueller, Mira
AU - Ernst, Susanne
AU - Ballarino, Paola
AU - Zellweger, Christa
AU - Moehring, Berit
AU - Vilaplana, Carles
AU - Freidank, Heike
AU - Mueller, Christian
PY - 2013/2
Y1 - 2013/2
N2 - 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 (95%Cl 0·56-0·65). When added to cardiac troponin T (cTnT), uric acid significantly increased the AUC of cTnT from 0·89 (95%Cl 0·85-0·93) to 0·92 (95%Cl 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.
AB - 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 (95%Cl 0·56-0·65). When added to cardiac troponin T (cTnT), uric acid significantly increased the AUC of cTnT from 0·89 (95%Cl 0·85-0·93) to 0·92 (95%Cl 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.
KW - Acute coronary syndrome
KW - Chest pain
KW - Diagnosis
KW - Mortality
KW - Uric acid
UR - http://www.scopus.com/inward/record.url?scp=84872613647&partnerID=8YFLogxK
U2 - 10.1111/eci.12029
DO - 10.1111/eci.12029
M3 - SCORING: Journal article
C2 - 23278361
AN - SCOPUS:84872613647
VL - 43
SP - 174
EP - 182
JO - EUR J CLIN INVEST
JF - EUR J CLIN INVEST
SN - 0014-2972
IS - 2
ER -
