The Correlation Of Serum Uric Acid Level With The Degree Of Coronary Artery Disease And Short-term Prognosis In Patients With Coronary Heart Disease

Objective:To study the correlation between serum uric acid(Uric acid SUA)level and the severity of coronary artery disease in patients with coronary heart disease(Coronary heart disease CHD),and to explore the predictive value of SUA for the main adverse cardiovascular events(major adverse cardiovascular events,MACE)within 1 years in CHD patients.Method:A total of 400 patients who underwent coronary angiography CAG in our department of cardiology from January 2016 to January 2017 were selected as the subjects.including301 cases of CHD,192 male,109 female,36-82 years old,99 non CHD patients,48 men,51 women,and age 31-79.The patient’s elbow vein blood was collected to detect SUA and related biochemical indexes in 24 h.According to the results of CAG,they were divided into CHD group and non CHD group,and the difference of general clinical data between the two groups was compared.According to the clinical classification of coronary heart disease,Gensini score and the number of lesions,the coronary heart disease components were divided into different subgroups,and the differences of general clinical data in each subgroup were further compared.and the correlation between SUA and Gensini score and the number of lesions was analyzed,further multivariate logistic regression analysis confirmed whether SUA is a risk factor for coronary heart disease.According to the four quantile method of SUA level,the patients were dividedinto groups of A,B,C and D from low to high,and the difference of general clinical data was compared between the four groups.All patients were given secondary prevention of coronary heart disease after discharge,and a one-year follow-up was conducted to record the occurrence of MACE events.According to the occurrence of MACE events,the patients were divided into MACE group and non MACE group.To explore the predictive efficacy of SUA on the occurrence of MACE events within 1 years outside the hospital for CHD patients.Results:(1)The level of SUA in group CHD was significantly higher than that in non CHD group(P < 0.05).(2)With the aggravation of the patients with coronary heart disease,the level of SUA increased gradually,and the group of acute myocardial infarction(AMI)> unstable angina pectoris(UA)> unstable angina(UA)group > stable angina(SAP)group.The difference between group AMI and group UA was statistically significant compared with group SAP(P < 0.05),but,there was no significant difference between the AMI group and the UA group(P>0.05).(3)With the increase of SUA level,Gensini scores also gradually increased,D group > C group > B group > A group,the differences between group D and group A,group B and group C were statistically significant(P<0.05),the differences between group C and group A and B were statistically significant(P<0.05),but there was no significant difference between group B and group A(P>0.05).(4)With the increase of Gensini score,the SUA level also gradually increased,the high-risk subgroup> middle-risk subgroup > low-risk subgroup,the difference between the two groups were statistically significant(P <0.05).(5)With the increase of the number of lesions,the level of SUA gradually increased,multi-vessel disease group> double-vessel disease group> single-vessel disease group.There was significant difference in multi-vessel disease group compared with single-vessel disease group and double-vessel disease group(P<0.05),but there was no significant difference between double-vessel disease group and single-vessel disease group(P>0.05).(6)Spearman correlation analysis showed that SUA was positively correlated with thenumber of lesions and Gensini scores.(7)Multivariate logistic regression analysis showed that SUA was a risk factor for coronary heart disease when adjusted for smoking,hypertension,diabetes,LDL,HbA1 c,and FBG.(8)For 1-year follow-up,61 patients with MACE occurred,accounting for 20.26%.SUA levels in patients with MACE were significantly higher than those in patients without MACE(P<0.001).Kaplan-Meier survival curves showed that with the increase of SUA levels,the probability of MACE events in patients with coronary heart disease gradually increased(P<0.001).Compared with group A,the probability of occurrence of MACE events in group B,group C,and group D increased significantly(P=0.002,P<0.001,P<0.001),compared with group C.The probability of occurrence of MACE events in group D was increased,but the difference was not statistically significant(P>0.05).Further multivariate Cox regression analysis showed that SUA(RR=1.004,95% CI 1.000-1.007,P<0.05)and Gensini score(RR=1.050,95% CI 1.040-1.060,P<0.001)It is suggested that SUA and Gensini scores are risk factors for the prognosis of coronary heart disease.According to the difference between MACE group and non-MACE group,the best cut-point value of SUA for the prognosis of patients with coronary heart disease was 303.5 using ROC curve.The sensitivity of this cut-point value for predictive diagnosis of MACE events was 0.948 and specificity was 0.454.The area under the curve was 0.756(95% CI 0.699-0.813P<0.001).Conclusion:1.The SUA levels in patients with coronary heart disease were significantly higher than those in patients without coronary heart disease.With the increase in the severity of coronary heart disease,the number of coronary artery lesions,and the degree of coronary artery stenosis,SUA levels gradually increased and showed a positive correlation.It suggests that SUA is a risk factor for coronary heart disease.2.A follow-up of 1 year in patients with coronary heart disease found that SUA levels in the MACE group were higher than those in the non-MACE group.With theincrease of SUA level,the probability of MACE events in patients with coronary heart disease gradually increased,suggesting that SUA is related to the short-term adverse prognosis of patients with coronary heart disease,which is a risk factor for the occurrence of MACE events in patients with coronary heart disease.It was also found that when SUA>303.5umol/L,the predictive value of MACE events in patients with coronary heart disease within 1 year was the greatest.SUA is expected to become a biochemical indicator that can predict the occurrence of MACE events.