Uric acid and prognosis in angiography-proven coronary artery disease

Background The optimal uric acid (UA) level associated with the lowest mortality and the strength of association between UA and mortality in various subgroups of patients with coronary artery disease (CAD) are unknown. Materials and methods This study included 13273 patients with angiographic confirmation of CAD and UA measurements available. The primary outcome analysis was 1-year mortality. Results Based on the receiver operating characteristic curve analysis, the best cut-off of UA for mortality prediction was 7 center dot 11mg/dL. Using this cut-off, patients were divided into two groups: the group with UA 7 center dot 11mg/dL (n=9075) and the group with UA >7 center dot 11mg/dL (n=4198). Cardiac mortality was 6 center dot 3% (256 deaths) in patients with UA >7 center dot 11mg/dL and 2 center dot 3% (201 deaths) in patients with UA 7 center dot 11mg/dL [hazard ratio (HR)=2 center dot 82, 95% confidence interval (CI) 2 center dot 363 center dot 36; P<0 center dot 001]. After adjustment for cardiovascular risk factors, UA remained an independent correlate of cardiac mortality (HR=1 center dot 20, 95% CI 1 center dot 081 center dot 34; P=0 center dot 001, for each standard deviation increase in the logarithmic scale of UA). The relationship between cardiac or all-cause mortality and UA showed a J-shaped pattern with lowest mortality in patients with UA between 5 center dot 17 and 6 center dot 76mg/dL. UA predicted mortality across all subgroups of patients, with strongest association in women and patients without arterial hypertension. Conclusions UA predicted an increased risk of cardiac mortality across all subgroups of patients with CAD. The association between UA and cardiac or all-cause mortality had a J-shaped' pattern with lowest risk of death in patients with UA levels between 5 center dot 17 and <6 center dot 76mg/dL.