| Background: Acute myocardial infarction(AMI) is one of the common clinical emergency, which is rapid-onset, rapid-change and high mortality in the disease. Acute myocardial infarction has become a global public health problem, and its incidence rising year by year has caused serious social and economic burden. Uric acid is the end product of purine metabolism in the body, and it is widely accepted that, except for people with congenital hereditary defect of purine metabolism, high uric acid level is one of the risk factors for atherosclerosis, and it can lead to hypertension, morbid obesity, insulin resistance, metabolic syndrome and renal dysfunction and other diseases. More and more studies show that elevated level of serum uric acid is closely associated with cardiovascular disease mortality, which is a strong predictor of long-term prognosis of patients with acute myocardial infarction [4]. However, for patients with acute myocardial infarction associated and chronic renal insufficiency, the prognosis between serum uric acid level in patients with acute myocardial infarction and the presence remains undetermined.Objective.:In this paper, we choosed acute myocardial infarction patients with renal insufficiency as subjects,to study the influence of serum uric acid concentration on the long-term prognosis of patients with acute myocardial infarction.Methods:We choosed the patients of 512 cases who were acute myocardial infarction with glomerular filtration rate less than 90 m L / min as research subjects to perform coronary angiography in the Department of Cardiology of the First Affiliated Hospital of Anhui Medical University during January 2012 to December 2013. Those Patients were divided into low uric acid group(male ≤420umol / L, femal ≤360 umol / L) and high uric acid group(male> 420 umol / L, femal> 360 umol / L) according to the uric acid levels in plasma. All patients were followed up for 48 months of telephone follow-up or clinic follow-up,and the two groups were compared on the long-term risk of serious cardiovascular adverse events. The primary endpoint was death, including cardiac death and other unexplained death. Secondary endpoints included revascularization, stroke, and heart failure.Results:The results showed that during 48 months follow-up, 2 cases were dead in low uric acid group, and 17 cases were dead in the high uric acid group(hazard ratio, 5.379; 95% confidence interval, 1.204 to 24.035; P=0.028). 6 patients in low uric acid group and 29 patients in high uric acid group were stoke(hazard ratio: 3.362; 95% confidence interval, 1.251-9.036; P = 0.016). 14 patients of low uric acid group patients and 78 patients of high uric acid group were heart failure(hazard ratio: 4.100; 95% confidence interval, 2.203-7.629; P <0.001).11 cases in low uric acid group and 21 cases in high uric acid group received revascularization(hazard ratio: 2.386; 95% confidence interval, 1.094-5.204; P = 0.029). Kaplan-Meier survival analysis showed that the incidence of stroke, heart failure and revascularization was significantly higher in high uric acid group.Conclusions:Uric acid level in acute myocardial infarction patients with chronic renal insufficiency is independent risk factor of poor prognosis. Compared with the low uric acid group, high uric acid level in acute myocardial infarction of patients with chronic renal insufficiency increases significantly on long-term mortality, incidence of heart failure, revascularization and stroke incidence. |
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