Serum Uric Acid in Acute Myocardial Infarction

Abstract

INTRODUCTION : India is in a stage of” epidemiologic transmission with declining infectious diseases and increasing incidence of ischemic heart diseases. There was a dramatic rise in the incidence of diseases like coronary artery disease. The”conventional risk factors are unable to explain this rising epidemic of ischemic heart disease completely. Role of uric acid in pathogenesis of acute MI has been debated since long. Some studies have reported a causal role of serum uric acid in acute MI whereas others have postulated that serum uric acid is an innocent bystander which is associated with other risk factors for cardiovascular diseases. Therefore it is unclear whether serum uric acid has causative role for the development of ischemic heart disease or simply acts as a passive marker of increased risk.” Amidst this controversy, it was decided to carry out this study to find the role of serum uric acid in acute MI. METHODOLOGY It is an observational study, total 75 cases of acute MI more than 18 years of age who presented to hospital within 24 hours of onset of symptoms were included in the study.“Acute MI was defined as, ‘increased myocardial enzyme concentrations with typical chest pain persisting more than 30 minutes or electrocardiographic changes (including ischemic ST-segment depression, ST-segment elevation or pathologic Q waves). Increased enzyme concentrations were defined as peak creatine phosphokinase level more than 2 times upper limit of normal”. Relevant history and measurements were entered in the predesigned proforma. xi Exclusion criteria: Patients with a condition known to elevate uric acid level e.g. chronic kidney disease, gout, haematological malignancy and hypothyroidism were excluded Patients receiving drugs affecting SUA levels (diuretics, ethambutol, pyrizinamide, salicylates, losartan, allopurinol, probenecid, atorvastatin, fenofibrate) & Chronic alcoholics were excluded. OBSERVATION & RESULTS There were 44 males and 31 females in the cases group with a 1.4:1 male preponderance. The mean age of the cases was 55.92 ± 12.38 years. There was statistically significant correlation between SUA and age (p = 0.002). It was also found that SUA levels among hypertensive patients had no correlation with normotensive patients(5.12 ± 1.77 v/s 5.21 ± 1.59, After applying t test p-0.826 not significant).It is observed that there is no correlation between serum uric acid level after acute myocardial infarction and diabetic status of patients. The mean SUA level among the patients who died was found to be significantly higher as compared to those who were discharged home and there was statistically significant correlation found between serum uric acid level and Killip’s class on day 0(p=0.000), day 3(p=0.000) and day 7(p=0.000). Patients of Killip’s class lll and lV had higher levels of uric acid as compared to patients of class l and ll. Out of 75 patients, 6 expired during 7 day follow up. All the patients who died had SUA level more than 7.0 mg/dl. Of these 6 patients one was in Killip’s class III and 5 patients were in Killip’s class IV at the time of admission. Thus, 100% of patients who died were in higher class i.e. class III and IV at time of admission. one patients shifted from killip’s class l to IV,one patient shifted from killip’s class ll to IV,one patient of Killip’s class III shifted to Killip’s class IV on day 3. All these 6 patients had SUA level on higher side. xii CONCLUSION: It therefore shows that serum uric acid concentration is significantly high in patients of AMI and has correlation with Killip’s class. Higher killips class had higher uric acid levels and was associated with poor prognosis after acute myocardial infarction. Hence SUA and killips class are good predictors of mortality in patients of acute myocardial infarction.