The association between uric acid-albumin ratio (UAR) with different diseases has been evaluated before. However, the association between UAR with spontaneous reperfusion (SR) in patients with ST-segment elevation myocardial infarction (STEMI) has not been explored.
STEMI patients admitted to our department and underwent primary coronary angiography between 1st November 2018 and 31st December 2020 were retrospectively enrolled. The patients were divided into the SR group and the non-SR group according to the index coronary angiography results. The association between UAR and SR was evaluated by uni-variable and multi-variable logistic analysis. Receiver operating characteristic curve analysis was used to determine the optimum cut-off level of UAR in predicting SR.
Three hundred and fifty-seven patients were finally enrolled in our study, 55 patients were divided into the SR group and 302 patients were divided into the non-SR group. In uni-variable analysis, patients with SR were older (P = 0.032), with higher red blood cell distribution width (P < 0.001) and red blood cell distribution width-to-platelet ratio (P < 0.001), higher level of C-reactive protein (P = 0.046), higher level of uric acid (P < 0.001) compared with patients without SR. Patients with SR had a lower level of platelets (P = 0.008), lower level of on-admission B-type natriuretic peptide (P < 0.001). As for the level of UAR, STEMI patients with SR had significantly higher levels of UAR compared with STEMI patients without SR [11.1 (8.9–13.4) vs. 8.3 (6.6–10.0), P < 0.001]. Further multi-variable logistic analysis reveals that UAR was the independent risk factor of SR in different models after adjusting different variables. Receiver operating characteristic analysis showed that UAR had good predictive value in SR (AUC = 0.75, 95% CI: 0.702–0.794, P < 0.01).
Our study shows that UAR is an independent risk factor for predicting SR in STEMI patients.
Walsh JL, Kotronias RA, Banning AP, et al. Interventional thrombus modification in STEMI. Nat Rev Cardiol 2024; 21: 435−436.
Shan TK, Qian LL, Han XD, et al. Symptom-to-balloon time and risk of ventricular arrhythmias in patients with STEMI undergoing percutaneous coronary intervention: the VERY-STEMI study. Int J Cardiol Cardiovasc Risk Prev 2024; 21: 200286.
Shahbazpour J, Abbasi M, Eskandari N, et al. Study of outcomes of delay in referral of patients with acute myocardial infarction. J Educ Health Promot 2022; 11: 95.
Ibanez B, James S, Agewall S, et al. 2017 ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the Task Force for management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2018; 39: 119−177.
Anderson HVS, Masri SC, Abdallah MS, et al. 2022 ACC/AHA key data elements and definitions for chest pain and acute myocardial infarction: a report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Data Standards. J Am Coll Cardiol 2022; 80: 1660−1700.
Lawton JS, Tamis-Holland JE, Bangalore S, et al. 2021 ACC/AHA/SCAI guideline for coronary artery revascularization: executive summary: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2022; 145: e4−e17.
Farag M, Peverelli M, Spinthakis N, et al. Spontaneous reperfusion in patients with transient ST-elevation myocardial infarction-prevalence, importance and approaches to management. Cardiovasc Drugs Ther 2023; 37: 169−180.
Li X, Li B, Gao J, et al. Influence of angiographic spontaneous coronary reperfusion on long-term prognosis in patients with ST-segment elevation myocardial infarction. Oncotarget 2017; 8: 79767−79774.
Stone GW, Cox D, Garcia E, et al. Normal flow (TIMI-3) before mechanical reperfusion therapy is an independent determinant of survival in acute myocardial infarction: analysis from the primary angioplasty in myocardial infarction trials. Circulation 2001; 104: 636−641.
Li J, Zhou Y, Zhang Y, et al. Admission homocysteine is an independent predictor of spontaneous reperfusion and early infarct-related artery patency before primary percutaneous coronary intervention in ST-segment elevation myocardial infarction. BMC Cardiovasc Disord 2018; 18: 125.
Rimar D, Crystal E, Battler A, et al. Improved prognosis of patients presenting with clinical marker of spontaneous reperfusion during acute myocardial infarction. Heart 2002; 88: 352−356.
Lemkes JS, Janssens GN, van der Hoeven NW, et al. Timing of revascularization in patients with transient ST-segment elevation myocardial infarction: a randomized clinical trial. Eur Heart J 2019; 40: 283−291.
Fefer P, Beigel R, Atar S, et al. Outcomes of patients presenting with clinical indices of spontaneous reperfusion in ST-elevation acute coronary syndrome undergoing deferred angiography. J Am Heart Assoc 2017; 6: e004552.
Leader JH, Kanji R, Gorog DA. Spontaneous reperfusion in STEMI: its mechanisms and possible modulation. Kardiol Pol 2024; 82: 363−374.
Guo J, Chen J, Wang G, et al. Plaque characteristics in patients with ST-segment elevation myocardial infarction and early spontaneous reperfusion. EuroIntervention 2021; 17: e664−e671.
Katsiki N, Dimitriadis GD, Mikhailidis DP. Serum uric acid and diabete: from pathophysiology to cardiovascular disease. Curr Pharm Des 2021; 27: 1941−1951.
Ji L, Shu P. A mendelian randomization study of serum uric acid with the risk of venous thromboembolism. Arthritis Res Ther 2023; 25: 122.
Lucijanic M, Krecak I, Galusic D, et al. Higher serum uric acid is associated with higher risks of thrombosis and death in patients with primary myelofibrosis. Wien Klin Wochenschr 2022; 134: 97−103.
Ren W, Huang Q, Fan K, et al. Uric acid played a role in the association between gender and deep vein thrombosis in patients with stroke. Nutr Metab Cardiovasc Dis 2021; 31: 2700−2706.
Qin A, Yang D, Wang S, et al. Uric acid-based ratios for predicting renal failure in Chinese IgA nephropathy patients. Int J Med Sci 2023; 20: 1584−1591.
Dikker O, Aktaş A, Şahin M, et al. The association of serum uric acid levels and various uric acid-related ratios with insulin resistance and obesity: preliminary study in adolescents. Children (Basel) 2023; 10: 1493.
Biter HI, Tosu AR. The prognostic significance of uric acid/albumin ratio in patients with aortic stenosis following transcatheter aortic valve implantation for major adverse cardiac and cerebral events. Medicina (Kaunas) 2023; 59: 686.
Liu W, Ding K, Bao J, et al. Relationship between uric acid to albumin ratio and in-stent restenosis in patients with coronary artery disease undergoing drug-eluting stenting. Coron Artery Dis 2023; 34: 589−594.
Şaylık F, Çınar T, Selçuk M, et al. The relationship between uric acid/albumin ratio and carotid intima-media thickness in patients with hypertension. Arq Bras Cardiol 2023; 120: e20220819.
Özgür Y, Akın S, Yılmaz NG, et al. Uric acid albumin ratio as a predictive marker of short-term mortality in patients with acute kidney injury. Clin Exp Emerg Med 2021; 8: 82−88.
Toprak K, Özen K, Memioğlu T, et al. Comparison of the effect of uric acid/albumin ratio on coronary slow flow with other inflammation-based markers. Biomark Med 2024; 18: 25−37.
Çınar T, Şaylık F, Hayıroğlu Mİ, et al. The association of serum uric acid/albumin ratio with no-reflow in patient with ST elevation myocardial infarction. Angiology 2023; 74: 381−386.
Sultana S, K MS, Prakash VR, et al. Evaluation of uric acid to albumin ratio as a marker of coronary artery disease severity in acute coronary syndromes: a cross-sectional study. Cureus 2023; 15: e49454.
Selçuk M, Çınar T, Şaylık F, et al. Predictive value of uric acid/albumin ratio for the prediction of new-onset atrial fibrillation in patients with ST-elevation myocardial infarction. Rev Invest Clin 2022; 74: 156−164.
Byrne RA, Rossello X, Coughlan JJ, et al. 2023 ESC guidelines for the management of acute coronary syndrome. Eur Heart J 2023; 44: 3720−3826.
Nurkoç SG, Karayiğit O. The association between no-reflow and serum uric acid/albumin ratio in patients with acute myocardial infarction without ST elevation. Angiology 2024; 75: 72−78.
Zhang XJ, Hou AJ, Luan B, et al. Uric acid to albumin ratio as a novel predictor for coronary slow flow phenomenon in patients with chronic coronary syndromes and non-obstructive coronary arteries. BMC Cardiovasc Disord 2024; 24: 358.
Llull L, Laredo C, Renú A, et al. Uric acid therapy improves clinical outcome in women with acute ischemic stroke. Stroke 2015; 46: 2162−2167.
Kikuchi K, Setoyama K, Tanaka E, et al. Uric acid enhances alteplase-mediated thrombolysis as an antioxidant. Sci Rep 2018; 8: 15844.
Çakmak EÖ, Bayam E, Çelik M, et al. Uric acid-to-albumin ratio: a novel marker for the extent of coronary artery disease in patients with non-ST-elevated myocardial infarction. Pulse (Basel) 2021; 8: 99−107.