Prognostic Significance of Uric Acid in Patients with Obstructive and Nonobstructive Coronary Artery Disease Undergoing D-SPECT

Figures & data

Table 1 Baseline Characteristics of Study Cohort by Serum Uric Acid

	All Patients (N=695)	Hyperuricemia (N=177)	Normouricemia (N=518)	p-value
Demography
Age	63.3±9.8	61.9±10.2	63.8±9.6	0.031
Male	392 (56.4)	103 (58.2)	289 (55.8)	0.578
Body mass index	24.9±3.1	26.0±3.2	24.5±3.0	<0.001
Current smoker	163 (23.5)	42 (23.7)	121 (23.4)	0.920
Family history of CAD	34 (4.9)	9 (5.1)	25 (4.8)	0.891
HEART Score	6 (4–7)	6 (3–7)	6 (4–7)	0.309
Medical history
Hypertension	424 (61.0)	121 (68.4)	303 (58.5)	0.020
Diabetes	171 (24.6)	42 (23.7)	129 (24.9)	0.754
Dyslipidemia	106 (15.3)	30 (16.9)	76 (14.7)	0.467
Prior stroke	107 (15.4)	23 (13.0)	84 (16.2)	0.305
Prior heart failure	15 (2.2)	7 (4.0)	8 (1.5)	0.057
Prior atrial fibrillation	44 (6.3)	19 (10.8)	25 (4.8)	0.005
Prior PCI	284 (40.9)	65 (36.7)	219 (42.3)	0.194
Admission presentation
Heart rate	76 (69–82)	78 (71–83)	76 (69–82)	0.088
Systolic BP	133 (119–147)	134 (122–149)	133 (118–147)	0.137
Diastolic BP	77 (69–85)	79 (71–87)	76 (68–84)	0.004
LVEF	63 (60–65)	62 (60–65)	63 (60–65)	0.002
Laboratory indices
CRP	3.02 (3.02–3.23)	3.02 (3.02–3.23)	3.02 (2.78–3.23)	0.363
Serum creatinine	72.0 (61.8–83.6)	75.1 (65.3–89.6)	70.9 (60.1–81.4)	<0.001
TC	3.79 (3.16–4.60)	4.22 (3.38–4.87)	3.69 (3.07–4.48)	<0.001
LDL-c	2.05 (1.52–2.77)	2.24 (1.69–2.98)	2.01 (1.45–2.67)	<0.001
Triglyceride	1.32 (0.97–1.95)	1.66 (1.10–2.33)	1.26 (0.95–1.78)	<0.001
Fasting glucose	5.2 (4.8–6.0)	5.3 (4.9–6.0)	5.2 (4.8–6.0)	0.340
Serum uric acid	5.6 (4.6–6.6)	7.5 (6.9–8.1)	5.1 (4.3–5.8)	<0.001
Peak TnT	0.008 (0.005–0.014)	0.008 (0.006–0.014)	0.008 (0.006–0.014)	0.089
Peak NT-pro BNP	71.2 (36.6–168.7)	70.2 (33.4–181.9)	73.3 (37.1–162.5)	0.969
D-SPECT characteristics
Summed stress score	3 (1–4)	2 (0–4)	3 (1–4)	0.504
Summed rest score	0 (0–1)	0 (0–1)	0 (0–1)	0.877
Summed difference score	2 (0–3)	2 (0–3)	2 (0–3)	0.168
Stress total perfusion defects	2 (1–5)	2 (1–5)	2 (1–5)	0.762
Location of defects				0.525
Apex	102 (12.0)	25 (17.5)	77 (18.8)
Anterior	199 (23.5)	49 (34.3)	150 (36.7)
Inferior or posterior	182 (21.5)	50 (35.0)	132 (32.3)
Septum	179 (21.1)	35 (24.5)	144 (35.2)
Lateral	185 (21.8)	45 (31.5)	140 (34.2)
Stress LVEF	65 (59–71)	65 (59–70)	65 (59–71)	0.336
Rest LVEF	67 (60–74)	66 (59–73)	67 (60–74)	0.240
Transient ischemic dilation	1.08 (1.01–1.18)	1.07 (0.99–1.16)	1.08 (1.01–1.18)	0.145
Medication at discharge
Aspirin	431 (62.0)	103 (58.2)	328 (63.3)	0.225
P2Y12 receptor antagonist	383 (55.1)	95 (53.7)	288 (55.6)	0.656
Statin	586 (84.3)	150 (84.7)	436 (84.2)	0.856
ACEI/ARB	304 (43.7)	85 (48.0)	219 (42.3)	0.183
β-blocker	322 (46.3)	85 (48.0)	237 (45.8)	0.601
CCB	275 (39.6)	75 (42.4)	200 (38.6)	0.377
Diuretic	73 (10.5)	22 (12.4)	51 (69.9)	0.333
Urate-lowering agent	11 (1.6)	7 (4.0)	4 (0.8)	0.003

Note: Values are presented as mean±SD, median (IQR), or n (%), as appropriate.

Abbreviations: ACEI/ARB, angiotensin-converting-enzyme inhibitors/angiotensin receptor blockers; BNP, brain natriuretic peptide; BP, blood pressure; CAD, coronary artery disease; CCB, calcium channel blocker; CRP, C-reactive protein; LDL, low-density lipoprotein; LVEF, left ventricular ejection fraction; PCI, percutaneous coronary intervention; TC, total cholesterol; TnT, troponin T.

Table 2 Risk of Cardiovascular Events by SUA Levels

			Unadjusted		Heart Score-Adjusted		Fully Adjusted^a
	MACE/Patients	%/Year (95% CI)	HR (95% CI)	p value	HR (95% CI)	p value	HR (95% CI)	p value
Whole cohort
Normouricemia	151/518	15.2 (12.9–17.8)	1.00	Reference	1.00	Reference	1.00	Reference
Hyperuricemia	66/177	21.1 (16.5–26.8)	1.42 (1.06–1.89)	0.018	1.46 (1.09–1.95)	0.011	1.39 (1.03–1.87)	0.033
Obstructive CAD
Normouricemia	111/322	18.8 (15.6–22.6)	1.00	Reference	1.00	Reference	1.00	Reference
Hyperuricemia	43/110	23.1 (17.1–31.1)	1.23 (0.87–1.75)	0.245	1.26 (0.89–1.80)	0.194	1.18 (0.82–1.72)	0.373
Nonobstructive CAD
Normouricemia	40/196	9.9 (7.3–13.5)	1.00	Reference	1.00	Reference	1.00	Reference
Hyperuricemia	23/67	18.1 (12.0–27.2)	1.91 (1.14–3.20)	0.013	2.01 (1.20–3.37)	0.008	1.80 (1.04–3.11)	0.035

Notes: ^aAdjustment for age, gender, current smoker, hypertension, diabetes, dyslipidemia, stroke, history of heart failure, creatinine, LVEF, and medication at discharge (aspirin, statin, ACEI/ARB, β-blocker, and diuretic).

Abbreviations: CAD, coronary artery disease; CI, confidence interval; HR, hazard ratio; MACE, major adverse cardiovascular events.

Figure 1 Long-term risk of MACE in the whole cohort (A) PSM cohort (B) obstructive CAD cohort (C) and nonobstructive CAD cohort (D) according to the SUA levels.

Abbreviations: CAD, coronary artery disease; MACE, major adverse cardiovascular events; PSM, propensity-score matching; SUA, serum uric acid.

Figure 2 The trajectories of SUA levels with MACE in the whole cohort (A) obstructive CAD cohort (B) nonobstructive CAD cohort (C) and low-, intermediate-, and high-risk cohorts stratified by HEART score (D–F) The solid line in each figure indicates the HR, and the dashed lines indicate the 95% CIs. The Orange reference line indicates an HR of 1.00. The median value of SUA levels (5.6 mg/dL) was treated as the reference. Other abbreviations referred to Figure 1.

Abbreviations: CI, confidence interval; HR, hazard ratio.

Figure 3 Subgroup analyses based on MPI characteristics in the whole cohort (A) obstructive CAD cohort (B) and nonobstructive CAD cohort (C) The risks were demonstrated as HRs and 95% CIs after adjustment for the HEART score.

Abbreviations: MPI, myocardial perfusion imaging; SDS, summed difference score; SRS, summed rest score; SSS, summed stress score; TID, transient ischemic dilation; TPD, total perfusion defects.