The Effect Of Serum Uric Acid/Albumin Ratio On MACEs In STEMI Patients After Direct Interventional Therapy

Objective:This study aimed to investigate the effect of serum uric acid/albumin ratio（UAR）on major adverse cardiovascular events（MACEs）in patients with acute ST-segment elevation myocardial infarction（STEMI）undergoing primary percutaneous coronary intervention（PPCI）.Methods:In this study,205 patients with acute STEMI treated by PPCI in the cardiac catheterization room of Hebei Provincial People’s Hospital from June 27^th,2020,to July 9^th,2021,were analyzed.The antecubital venous blood was taken immediately after the patient was admitted to our hospital to detect serum uric acid and albumin.The ROC curve was used to evaluate the ability of UAR for the composite endpoint MACEs,and the maximum Oden index was calculated to obtain the best UAR.According to the optimal cut-off value of UAR,the patients were divided into a high UAR group（UAR≥10.735）and a low UAR group（UAR<10.735）.The MACEs events of patients before October 31^st,2022were counted by logging into Neusoft Medical Information Management System for relevant medical record inquiry,telephone consultation and outpatient survey.The main observation endpoint of MACEs is the composite endpoint event of cardiac death,admission to hospital due to heart failure,target vessel revascularization,myocardial infarction,and stroke.The baseline data,PPCI-related intervention data,and MACEs events of the two groups were analyzed and compared.Results:The baseline data showed that compared with the low UAR group,patients in the high UAR group showed higher white blood cell count[9.92（7.75～11.70）vs.11.61（8.23～14.49）,P=0.003],higher creatinine levels[65.90（59.23～76.78）vs.78.20（67.95～90.60）,P<0.001],higher serum uric acid levels[316.20（262.93～363.30）vs.448.90（425.25～490.35）,P<0.001],higher NT-pro BNP peak level[890.25（469.78～1435.75）vs.1323（674.50～2394.00）,P=0.005];the albumin level was lower（39.93±3.82 vs.35.59±4.50,P<0.001）,and kidney pellet filtration rate was lower（and the glomerular filtration rate was lower）[96.58（88.59～106.23）vs.84.97（76.26～98.18）,P<0.001].The results of PPCI-related intervention data in the two groups showed that compared with the low UAR group,the proportion of patients with coronary thrombosis in the high UAR group was（35.90%vs.53.06%,P=0.032）and the proportion of intraoperative thrombus aspiration was（23.6%vs.29.6%,P=0.007）higher.Related MACEs events,compared with the low UAR group,the event rate of MACEs in the high UAR group due to heart failure（3.21%vs.22.45%,P<0.001）and the composite endpoint MACEs event rate（10.26%vs.36.73%,P<0.001）were higher.The area under the UAR curve was 0.662（95%CI0.543～0.781,P=0.003）,and the optimal cut-off value of UAR was 10.735（sensitivity 52.9%,specificity 81.9%）by calculating the largest Youden index.The Kaplan-Meier survival curve showed that the cumulative survival rate of composite endpoint MACEs events（P<0.001）and hospital admission for heart failure（P<0.001）in the high UAR group was significantly lower than that in the low UAR group.The Cox proportional hazard regression model showed that UAR≥10.735（HR3.180,95%CI1.438～7.032,P=0.004）was an independent risk factor for the composite endpoint MACEs,and UAR≥10.735（HR5.980,95%CI1.674～21.365,P=0.006）was an independent risk factor for MACEs hospital admissions due to heart failure.Conclusion:UAR≥10.735 on admission is an independent risk factor for MACEs,a composite endpoint event,including cardiac death,admission due to heart failure,target vessel revascularization,myocardial infarction,and stroke.UAR≥10.735 at admission is an independent risk factor for hospital admission to MACEs due to heart failure.UAR in patients with STEMI after PPCI has a certain predictive value for long-term major adverse cardiovascular events.