To investigate the relationship between serum uric acid and long-term prognosis in AMI patients.

One thousand and ninety-eight AMI patients from 9 hospitals (Chengdu First People's Hospital, Chengdu Second People's Hospital, the Third People's Hospital of Chengdu, the First Affiliated Hospital of Chengdu Medical College, Dujiangyan Medical Center, Pidu District People's Hospital, Chengdu, Shuangliu District First People's Hospital, Jintang First People's Hospital, the People's Hospital of Pengzhou) in Chengdu during September 2016 to July 2019 were consecutively reSScruited. Baseline data were collected via the electronic medical record system of each hospital by trained professionals, including: (1) demographic data: age, gender, prevalence of smoking; (2) clinical complications and related information: hypertension, diabetes, blood pressure, heart rate, Killip class, AMI type (NSTEMI or STEMI) , prevalence of percutaneous coronary intervention (PCI) ; (3) laboratory parameters: serum SScreatinine (Scr) , uric acid (UA) , triglyceride (TG) , total cholesterol (TC) , low-density lipoprotein cholesterol (LDL-C) , high-density lipoprotein cholesterol (HDL-C) , estimated glomerular filtration rate (eGFR) ; (4) post-discharge medication: aspirin, clopidogrel/tigrelol, statins, Beta-blockers, ACEI/ARB, diuretics. Baseline data were compared between patients with and without major adverse cardiovascular and cerebrovascular events (MACCE) during post-discharge follow-up. Then, prognosis was compared aSScross UA tertile subgroups〔A: UA<420 μmol/L; B: 420 ≤UA<480 μmol/L; C: UA≥480 μmol/L〕 stratified by the diagnostic SScriteria for hyperuricemia in Guideline for the Diagnosis and Management of Hyperuricemia and Gout in China (2019) .

The median follow-up time for all participants was 14.5 (9.2, 20.7) months. Of all cases, 173 were found with MACCE, and 366 with hyperuricemia. Compared with those without MACCE, patients with MACCE had greater average age, Scr and UA, and heart rate, and higher female ratio, higher prevalence of hypertension, diabetes, use of diuretics, and Killip class≥3, but lower prevalence of PCI treatment (P<0.05) . Subgroup A had much lower incidence of MACCE, all-cause death and cardiac death than subgroup B or C (P<0.01) . Kaplan-Meier survival analysis indicated that the cumulative incidence of MACCE, all-cause death and cardiac death either in subgroup B or C was higher than that in subgroup A (P<0.01) . Cox regression analysis showed that Killip class ≥3〔HR=1.812, 95%CI (1.215, 2.700) 〕, older age〔HR=1.045, 95%CI (1.031, 1.059) 〕 and higher UA level〔 (≥420 μmol/L but<480 μmol/L: HR=1.614, 95%CI (1.062, 2.455) ; ≥480 μmol/L: HR=1.949, 95%CI (1.327, 2.862) 〕 were independent risk factors for long-term MACCE events in patients with AMI (P<0.05) . Serum UA had an AUC (95%CI) of 0.578 (0.548, 0.607) with 0.387 sensitivity, and 0.779 specificity in predicting long-term incidence of MACCE, an AUC (95%CI) of 0.645 (0.616, 0.674) with 0.598 sensitivity, and 0.670 specificity in predicting long-term incidence of all-cause death, and an AUC (95% CI) of 0.653 (0.624, 0.681) with 0.534 sensitivity, and 0.761 specificity in predicting long-term incidence of cardiac death.

Elevated serum UA was associated with higher risk of long-term adverse events in AMI patients. Serum UA may be used as a predictor for long-term MACCE events in such patients.

探讨UA水平与AMI患者远期预后的关系。

连续纳入2016年9月至2019年7月于成都市9家医院（成都市第一人民医院、成都市第二人民医院、成都市第三人民医院、成都医学院第一附属医院、都江堰市医疗中心、成都市郫都区人民医院、成都市双流区第一人民医院、金堂县第一人民医院、彭州市人民医院）就诊的1 098例AMI患者，由经过培训的专业人员通过各医院电子病历系统收集相关基线资料，包括：（1）人口学资料：年龄、性别、吸烟情况；（2）临床合并症及相关资料：高血压、糖尿病、血压、心率、Killip分级、AMI类型〔急性非ST段抬高型心肌梗死（NSTEMI）/急性ST段抬高型心肌梗死（STEMI）〕、是否接受经皮冠状动脉介入治疗（PCI）；（3）实验室检查：血肌酐（Scr）、UA、三酰甘油（TG）、总胆固醇（CHO）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、估算肾小球滤过率（eGFR）；（4）出院后用药情况：阿司匹林、氯吡格雷/替格瑞洛、他汀类、β-受体阻滞剂、血管紧张素转换酶抑制剂（ACEI）/血管紧张素受体阻滞剂（ARB）、利尿剂。通过门诊或电话询问并记录出院后随访期间主要心脑血管不良事件（MACCE）发生情况并以此为随访终点事件。依据随访期间是否发生MACCE将患者分为MACCE组、无MACCE组，比较两组患者基线资料。再根据《中国高尿酸血症与痛风诊疗指南（2019）》将患者分为A组：UA<420 μmol/L，B组：420≤UA<480 μmol/L，C组：UA≥480 μmol/L，观察不同UA水平患者的预后差异。

中位随访时间14.5（9.2，20.7）个月。1 098例AMI患者中发生MACCE 173例（MACCE组），高尿酸血症366例。MACCE组患者年龄大于无MACCE组，Scr、UA、心率、女性比例、合并高血压比例、合并糖尿病比例、使用利尿剂比例以及Killip分级≥3级比例高于无MACCE组，接受PCI治疗比例低于无MACCE组（P<0.05）；B组和C组MACCE、全因死亡以及心源性死亡发生率高于A组（P<0.01）；Kaplan-Meier生存分析显示B组和C组MACCE、全因死亡、心源性死亡事件的累积发生率高于A组（P<0.01）。多因素Cox比例风险回归分析显示，Killip分级≥3级〔HR=1.812，95%CI（1.215，2.700）〕、高龄〔HR=1.045，95%CI（1.031，1.059）〕以及较高的UA水平〔B组：HR=1.614，95%CI（1.062，2.455）；C组：HR=1.949，95%CI（1.327，2.862）〕是AMI患者发生远期MACCE的独立危险因素（P<0.05）。UA预测AMI患者远期不良事件（MACCE、全因死亡、心源性死亡）的ROC曲线下面积（AUC）（95%CI）分别为0.578（0.548，0.607）、0.645（0.616，0.674）、0.653（0.624，0.681），灵敏度分别为0.387、0.598、0.534，特异度分别为0.779、0.670、0.761。

较高UA水平的AMI患者远期不良事件的发生率更高，其是AMI患者发生远期MACCE的独立预测因素。